NPIMap

Organization Active NPI

Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Ripley, MS
National Provider Identifier
1447769559
Registry record updated Oct 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAST PACE MISSISSIPPI, PLLC
Practice address
517 City Ave S
Ripley, MS 38663
Phone
(662) 587-8206
Fax
(662) 587-8207
NPI assigned
Sep 21, 2017
Last updated
Oct 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sydni Clemmons
Title
Credentialing Manager
Phone
(901) 351-1791

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Rural Health Clinic/Center 261QR1300X Primary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

517 City Ave S
Ripley, MS 38663

Mailing address

6550 Carothers Pkwy Ste 225
Franklin, TN 37067-6662
Phone (931) 253-1110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180111000291 MS Part B Supplier - Clinic/Group Practice 3678832029 Receives reassigned benefits from 458 practitioners
Practice locations: Ripley, MS; Magee, MS; McComb, MS; Meridian, MS; Natchez, MS; Newton, MS; Olive Branch, MS; Philadelphia, MS…
O20211217001505 MS Part A Provider - Rural Health Clinic 3678832029 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ripley, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447769559. Details of each certification follow.

Rural health clinic certification: CCN A53819

Legal name
FAST PACE MISSISSIPPI PLLC
Doing business as
FAST PACE HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 1, 2022
Last certification
Feb 1, 2022
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Sep 5, 2017 in MS
Enrollment address
517 City Ave S
Ripley, MS 38663-2517

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

760 Brookway Blvd
Brookhaven, MS 39601
Phone (601) 748-7270

619 S State St
Clarksdale, MS 38614
Phone (662) 812-1229

1050 Highway 98 Byp
Columbia, MS 39429
Phone (601) 522-2095

700 Sunset Dr
Grenada, MS 38901
Phone (662) 307-2884

533 Lake St
Hazlehurst, MS 39083
Phone (601) 533-5253

602 Craft St
Holly Springs, MS 38635
Phone (662) 333-8070

603 Craft St
Holly Springs, MS 38635
Phone (662) 333-8070

1038 Northwest Ave
McComb, MS 39648
Phone (601) 730-7012

508 Highway 61 N
Natchez, MS 39120
Phone (601) 861-1631

296 Eastside Dr
Newton, MS 39345
Phone (601) 228-8985

907 Highway 49 S
Richland, MS 39218
Phone (601) 374-5263

1612 E County Line Rd
Ridgeland, MS 39157
Phone (601) 429-1160

1161 Church Rd W
Southaven, MS 38671
Phone (662) 253-1067

934 S Gloster St
Tupelo, MS 38801
Phone (623) 465-9466

451 Highway 90
Waveland, MS 39576
Phone (228) 400-0055

1130 Frontage Dr W
Wiggins, MS 39577
Phone (601) 716-8012

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sydni Clemmons Individual Corporate DirectorCredentialing Director Dec 10, 2021
W-2 Managing EmployeeCredentialing Director Dec 10, 2021
Dana Kay Martin Individual 5% Or Greater Direct Ownership Interest May 1, 2019 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 470

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 470

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634256000000",
    "number": "1447769559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6550 CAROTHERS PKWY STE 225",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370676662",
            "telephone_number": "931-253-1110",
            "fax_number": "931-253-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 CITY AVE S",
            "city": "RIPLEY",
            "state": "MS",
            "postal_code": "38663",
            "telephone_number": "662-587-8206",
            "fax_number": "662-587-8207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE MISSISSIPPI, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-21",
        "last_updated": "2021-10-15",
        "certification_date": "2021-10-15",
        "status": "A",
        "authorized_official_last_name": "CLEMMONS",
        "authorized_official_first_name": "SYDNI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "901-351-1791"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ripley, MS

Sources for this page

Verify at the official NPI Registry.