NPIMap

Organization Active NPI

Fast Pace Mississippi, PLLC

Doing business as Fast Pace Health

  • Urgent Care Clinic/Center
  • Greenbriar, AR
National Provider Identifier
1982361259
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
FAST PACE MISSISSIPPI, PLLC
Doing business as
Fast Pace Health
Practice address
32 S. Broadway Street
Greenbriar, AR 72058-9601
Phone
(931) 253-1110
NPI assigned
Nov 22, 2021
Last updated
Aug 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2024

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

Authorized official

Name
Melissa Harlan
Title
Director Credentialing & Enrollment
Phone
(615) 948-9639

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

32 S. Broadway Street
Greenbriar, AR 72058-9601

Mailing address

PO Box 306593
Nashville, TN 37230-6593

Other names 1

  • Fast Pace Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20211223000270 MS Part A Provider - Rural Health Clinic 3678832029 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wiggins, MS
O20240419001210 AR Part B Supplier - Clinic/Group Practice 3678832029 Receives reassigned benefits from 51 practitioners
Practice locations: Russellville, AR; Siloam Springs, AR; Searcy, AR; Mountain Home, AR; Jonesboro, AR; Hot Springs, AR; Hope, AR; Greenbrier, AR…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982361259. Details of each certification follow.

Rural health clinic certification: CCN A53822

Legal name
FAST PACE MISSISSIPPI 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
OtherProprietary
Incorporated
Sep 15, 2017 in MS
Enrollment address
1130 West Frontage Dr
Wiggins, MS 39577-8165

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

2304 N Hervey St
Hope, AR 71801

812 N Arkansas Ave
Russellville, AR 72801
Phone (479) 449-1085

2315 W Beebe Capps Expy
Searcy, AR 72143
Phone (501) 236-5131

1130 Frontage Dr W
Wiggins, MS 39577
Phone (601) 716-8012

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Sydni Clemmons Individual Corporate DirectorDirector of Credentialing Dec 1, 2021
W-2 Managing EmployeeDirector of Credentialing Dec 1, 2021
Dana Kay Martin Individual 5% Or Greater Direct Ownership Interest Dec 1, 2021 100%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 53

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 53

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": "1722556800000",
    "number": "1982361259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306593",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 S. BROADWAY STREET",
            "city": "GREENBRIAR",
            "state": "AR",
            "postal_code": "720589601",
            "telephone_number": "931-253-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE MISSISSIPPI, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-22",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "HARLAN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "DIRECTOR CREDENTIALING & ENROLLMENT",
        "authorized_official_telephone_number": "615-948-9639"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fast Pace Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fast Pace Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Sources for this page

Verify at the official NPI Registry.