NPIMap

Organization Active NPI

Fast Pace Medical Clinic PLLC

  • Family Medicine Physician
  • Hanover, IN
National Provider Identifier
1649770769
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAST PACE MEDICAL CLINIC PLLC
Practice address
4152 W State Road
Hanover, IN 47243
Phone
(931) 253-1110
Fax
(931) 722-9919
NPI assigned
Feb 15, 2018
Last updated
Mar 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Urgent Care Clinic/Center 261QU0200X NU

Addresses

Primary practice location

4152 W State Road
Hanover, IN 47243

Mailing address

PO Box 1258
Waynesboro, TN 38485-1258
Phone (931) 253-1110

Other identifiers 1

IdentifierTypeStateIssuer
300036022MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200827001491 IN Part B Supplier - Clinic/Group Practice 5395881841 Receives reassigned benefits from 218 practitioners
Practice locations: Martinsville, IN; North Vernon, IN; New Castle, IN; Peru, IN; Portland, IN; Princeton, IN; Richmond, IN; Rochester, IN…

Other NPIs with the same Medicare PAC ID 14

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

View all 14

National Provider Directory

National Provider Directory

Locations

115 E Main St
Attica, IN 47918
Phone (765) 764-0085

1010 N Main St
Bluffton, IN 46714
Phone (260) 261-1385

1317 N State St
Greenfield, IN 46140
Phone (317) 967-2167

1569 A St NE
Linton, IN 47441
Phone (812) 846-3380

815 N Lincoln Rd
Rockville, IN 47872
Phone (337) 282-1096

441 S Illinois Ave
Oak Ridge, TN 37830
Phone (865) 685-0767

Practitioners & affiliated clinicians

Practitioners 224

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 224

NPI Registry JSON

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

{
    "created_epoch": "1518652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1649770769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1258",
            "city": "WAYNESBORO",
            "state": "TN",
            "postal_code": "384851258",
            "telephone_number": "931-253-1110",
            "fax_number": "931-722-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4152 W STATE ROAD",
            "city": "HANOVER",
            "state": "IN",
            "postal_code": "47243",
            "telephone_number": "931-253-1110",
            "fax_number": "931-722-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-15",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300036022",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hanover, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.