Fast Pace Medical Clinic PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FAST PACE MEDICAL CLINIC PLLC

Practice address

2731 Allison Bonnett Memorial Dr
Hueytown, AL 35023-1854

Phone

(205) 548-4102

Fax

(205) 548-4103

NPI assigned

Nov 1, 2021

Organization subpart

No

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

(931) 253-1110

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Rural health clinic certification: CCN 883886

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

1A

Organization structure

OtherProprietary

Incorporated

Oct 5, 2009 in TN

Enrollment address

7234 Tazewell Pike
Corryton, TN 37721-3550

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

  O20211123001250

  Same enrollment

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

CLIA laboratory certificates

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.

Owners & managing parties with NPI records 3

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

• Selena Michelle Gurley, CRNP

  • Family Nurse Practitioner
  • Florence, AL
  • NPI 1215214432

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Karen Denise Daingerfield, FNP

  • Family Nurse Practitioner
  • McMinnville, TN
  • NPI 1538594494

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Dana Kay Martin, C.F.N.P.

  • Family Nurse Practitioner
  • Selmer, TN
  • NPI 1497781454

  5% Or Greater Direct Ownership Interest

  CMS ownership

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

{
    "created_epoch": "1635724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663545600000",
    "number": "1942965306",
    "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": "2731 ALLISON BONNETT MEMORIAL DR",
            "city": "HUEYTOWN",
            "state": "AL",
            "postal_code": "350231854",
            "telephone_number": "205-548-4102",
            "fax_number": "205-548-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-01",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A",
        "authorized_official_last_name": "CLEMMONS",
        "authorized_official_first_name": "SYDNI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "931-253-1110"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAID",
            "identifier": "2996",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erika Lavon Edwards
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• Stephanie Michelle Fant, PT, DPT
• William Calvin Ferguson Jr., M.D.
• Spencer Paul Flint
• Freds Stores of Tennessee Inc
• Ronda Lea Freeman, CRNP
• Drew W Gann, OD, MS

• Family Medicine Physician in Hueytown, AL
• Providers in Hueytown, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.