NPIMap

Organization Active NPI

Fast Pace Kentucky, PLLC

  • Rural Health Clinic/Center
  • Brendenburg, KY
National Provider Identifier
1457072605
Registry record updated Sep 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAST PACE KENTUCKY, PLLC
Practice address
270 Bypass Road
Brendenburg, KY 40108-1743
Phone
(931) 253-1110
NPI assigned
Sep 7, 2022
Last updated
Sep 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

270 Bypass Road
Brendenburg, KY 40108-1743

Mailing address

PO Box 306414
Nashville, TN 37230-6414
Phone (931) 253-1110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221025003463 KY Part A Provider - Rural Health Clinic 0143525998 Practice locations: Brandenburg, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457072605. Details of each certification follow.

Rural health clinic certification: CCN B03899

Legal name
FAST PACE KENTUCKY, PLLC
Doing business as
FAST PACE HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 18, 2022
Last certification
Nov 18, 2022
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Dec 21, 2015 in KY
Enrollment address
270 Bypass Rd
Brandenburg, KY 40108-1743

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2266516Fast Pace Kentucky, PLLC270 Bypass Road, Brandenburg, KY 40108Certificate of waiverAug 10, 2026

National Provider Directory

National Provider Directory
Tax ID family
Fast Pace Kentucky PLLC44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Locations

1873 Cumberland Falls Hwy
Corbin, KY 40701
Phone (606) 404-6450

919 N Main St
Madisonville, KY 42431
Phone (270) 228-0592

895 N Main St
Monticello, KY 42633
Phone (606) 396-3006

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Barry Louis Taylor Individual 5% Or Greater Direct Ownership Interest Oct 5, 2019 33.33%
Sydni Clemmons Individual Corporate DirectorDirector of Credentialing Sep 7, 2022
W-2 Managing EmployeeDirector of Credentialing Sep 7, 2022
Karen Denise Daingerfield Individual 5% Or Greater Direct Ownership Interest Oct 5, 2019 33.33%
Dana Kay Martin Individual 5% Or Greater Direct Ownership Interest Oct 5, 2019 33.33%

Owners & managing parties with NPI records 3

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

NPI Registry JSON

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

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662508800000",
    "number": "1457072605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306414",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306414",
            "telephone_number": "931-253-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 BYPASS ROAD",
            "city": "BRENDENBURG",
            "state": "KY",
            "postal_code": "401081743",
            "telephone_number": "931-253-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE KENTUCKY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-07",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-02",
        "status": "A",
        "authorized_official_last_name": "CLEMMONS",
        "authorized_official_first_name": "SYDNI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGE",
        "authorized_official_telephone_number": "901-351-1791"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.