NPIMap

Organization Active NPI

Fast Pace Kentucky, PLLC

  • Rural Health Clinic/Center
  • Leitchfield, KY
National Provider Identifier
1891452157
Registry record updated Nov 22, 2021
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
333 S Main St
Leitchfield, KY 42754-1427
Phone
(270) 200-4983
NPI assigned
Nov 22, 2021
Last updated
Nov 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2021

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 1

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

Addresses

Primary practice location

333 S Main St
Leitchfield, KY 42754-1427

Mailing address

PO Box 306414
Nashville, TN 37230-6414

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220120002673 KY Part A Provider - Rural Health Clinic 0143525998 1 other NPI on this enrollment
Practice locations: Leitchfield, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891452157. Details of each certification follow.

Rural health clinic certification: CCN B03868

Legal name
FAST PACE KENTUCKY, PLLC
Doing business as
FAST PACE HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 11, 2022
Last certification
Feb 11, 2022
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Dec 21, 2015 in KY
Enrollment address
333 S Main St
Leitchfield, KY 42754-1427

Other NPIs on the same Medicare enrollment 1

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

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
18D2136650Fast Pace Kentucky, PLLC333 South Main Street, Leitchfield, KY 42754Certificate of waiverSep 12, 2027

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

333 S Main St
Leitchfield, KY 42754
Phone (270) 200-4983

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 May 1, 2019 33.33%
Sydni Clemmons Individual Corporate DirectorDirector of Credentialing Dec 2, 2021
W-2 Managing Employee Dec 2, 2021
Karen Denise Daingerfield Individual 5% Or Greater Direct Ownership Interest May 1, 2019 33.33%
Dana Kay Martin Individual 5% Or Greater Direct Ownership Interest May 1, 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": "1637539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637539200000",
    "number": "1891452157",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 S MAIN ST",
            "city": "LEITCHFIELD",
            "state": "KY",
            "postal_code": "427541427",
            "telephone_number": "270-200-4983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE KENTUCKY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-22",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leitchfield, KY

Sources for this page

Verify at the official NPI Registry.