Custom Clinic, P.A.
NPI 1699859124 · Family Medicine Physician · Fairmont, MN
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Custom Clinic, P.A. is a Family Medicine Physician organization in Fairmont, MN (NPI 1699859124).
Provider details
- NPI number
- 1699859124
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Timothy Bachenberg, President(507) 236-2880
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Smart Clinic
Registry dates
- Enumerated
- 2006-10-24
- Last updated
- 2020-08-22
Frequently asked questions
- What is Custom Clinic, P.A.'s NPI number?
- Custom Clinic, P.A.'s National Provider Identifier (NPI) is 1699859124, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Custom Clinic, P.A.?
- Custom Clinic, P.A. is classified in the NPPES registry as Family Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is Custom Clinic, P.A. located?
- Custom Clinic, P.A.'s practice location on file with NPPES is 322 S State St, Fairmont, MN 56031-4139.
- What is Custom Clinic, P.A.'s phone number?
- The practice phone number listed in the NPPES registry for Custom Clinic, P.A. is (507) 236-2880.
- Does Custom Clinic, P.A. accept Medicare?
- Custom Clinic, P.A. is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Custom Clinic, P.A.?
- The authorized official listed on Custom Clinic, P.A.'s NPPES record is Timothy Bachenberg, President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Custom Clinic, P.A.'s NPI active?
- Yes — Custom Clinic, P.A.'s NPI (1699859124) is active in the NPPES registry as of the last update on 2020-08-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.