Fast Pace Medical Clinic PLLC

Key facts

NPI: 1619632817
Entity type: Organization (NPI type 2)
Primary specialty: Rural Health Clinic/Center 261QR1300X
Legal business name: FAST PACE MEDICAL CLINIC PLLC
Practice address: 731 New Highway 68 Ste 1
Sweetwater, TN 37874-1946
Phone: (423) 836-9304
Fax: (423) 836-9309
NPI assigned: Nov 2, 2021
Organization subpart: No

Authorized official

Name: Robert Benson
Title: Coo
Phone: (931) 253-1110

Owners & managing parties with NPI records 3

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

Karen Denise Daingerfield, FNP Family Nurse Practitioner · McMinnville, TN · NPI 1538594494

CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST
Dana Kay Martin, C.F.N.P. Family Nurse Practitioner · Selmer, TN · NPI 1497781454

CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST
Selena Michelle Gurley, CRNP Family Nurse Practitioner · Florence, AL · NPI 1215214432

CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST

Other NPIs on the same Medicare enrollment 1

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

Fast Pace Medical Clinic PLLC Rural Health Clinic/Center · Chapel Hill, TN · NPI 1316602774

Same enrollment O20211202000516

Medicare participation

Medicare fee-for-service enrollment: Enrolled in TN

Rural health clinic certification: CCN 883905

Legal name: FAST PACE MEDICAL CLINIC 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: Other · Proprietary
Incorporated: Oct 5, 2009 in TN
Enrollment address: 2280 S Shady St
Mountain City, TN 37683

All disclosed owners & managing parties 5

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

Name	Role	Since	Share
Melissa Harlan Individual	W-2 Managing Employee Delegated Official	Jan 1, 2024
Selena Michelle Gurley Individual	5% Or Greater Direct Ownership Interest Owner	Oct 5, 2019	33.33%
Christy Littlejohn Individual	W-2 Managing Employee Delegated Official	Jan 1, 2024
Karen Denise Daingerfield Individual	5% Or Greater Direct Ownership Interest Owner	Oct 5, 2019	33.33%
Dana Kay Martin Individual	5% Or Greater Direct Ownership Interest Owner	Oct 5, 2019	33.33%

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20211202000516	TN	Part a Provider - Rural Health Clinic	5395881841	1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mountain City, TN

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Rural Health Clinic/Center	261QR1300X			Yes

Addresses

Primary practice location

731 New Highway 68 Ste 1
Sweetwater, TN 37874-1946

Mailing address

PO Box 306244
Nashville, TN 37230-6244

Other identifiers

Identifier	Type	State	Issuer
1515574	Medicaid	TN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 2, 2021.

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635811200000",
    "number": "1619632817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306244",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 NEW HIGHWAY 68 STE 1",
            "city": "SWEETWATER",
            "state": "TN",
            "postal_code": "378741946",
            "telephone_number": "423-836-9304",
            "fax_number": "423-836-9309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-02",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A",
        "authorized_official_last_name": "BENSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "931-253-1110"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1515574",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sweetwater, TN

All providers in Sweetwater, TN · Rural Health Clinic/Center in Tennessee

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.