NPIMap

Organization Active NPI

Fast Pace Kentucky, PLLC

  • Rural Health Clinic/Center
  • Corbin, KY
National Provider Identifier
1639899164
Registry record updated Sep 2, 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
1871 Cumberland Falls Hwy
Corbin, KY 40701-2731
Phone
(931) 253-1110
NPI assigned
Sep 2, 2022
Last updated
Sep 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2022

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 1

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

Addresses

Primary practice location

1871 Cumberland Falls Hwy
Corbin, KY 40701-2731

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
O20221019000216 KY Part A Provider - Rural Health Clinic 0143525998 Practice locations: Corbin, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639899164. Details of each certification follow.

Rural health clinic certification: CCN B03898

Legal name
FAST PACE KENTUCKY, PLLC
Doing business as
FAST PACE HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 1, 2022
Last certification
Dec 1, 2022
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Dec 21, 2015 in KY
Enrollment address
1873 Cumberland Falls Highway
Corbin, KY 40701-2731

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
18D2266437Fast Pace Kentucky, PLLC1873 Cumberland Falls Highway, Corbin, KY 40701Certificate of waiverAug 9, 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

1000 W Park Dr
Lawrenceburg, KY 40342
Phone (502) 353-3417

145 Brookeway Dr
Mt Washington, KY 40047
Phone (502) 538-2430

1023 W Main St
Princeton, KY 42445
Phone (270) 254-5840

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 Sep 7, 2022 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.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1662076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662076800000",
    "number": "1639899164",
    "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": "1871 CUMBERLAND FALLS HWY",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407012731",
            "telephone_number": "931-253-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE KENTUCKY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-02",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corbin, KY

Sources for this page

Verify at the official NPI Registry.