SMART CLINIC
NPI 1699859124
Family Medicine in Fairmont, MN
About Smart Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SMART CLINIC (NPI 1699859124) is a healthcare organization registered as a family medicine in Fairmont, Minnesota and active in the NPI registry since October 2006. The organization lists Timothy C Bachenberg, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Smart Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Smart Clinic, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Custom Clinic, P.A.'s NPI number?
The NPI number for Custom Clinic, P.A. is 1699859124. It was assigned to this organization in the NPPES registry on October 24, 2006. The provider is doing business as Smart Clinic.
Where is Custom Clinic, P.A. located?
Custom Clinic, P.A. is located at 322 S State St 5 Lake Center Drive, Fairmont, MN 56031. The listed phone number is (507) 236-2880.
What is Custom Clinic, P.A.'s specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Custom Clinic, P.A. enrolled in Medicare?
Yes. Custom Clinic, P.A. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Custom Clinic, P.A.?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (General Practice) reassigns their Medicare billing to Custom Clinic, P.A.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Custom Clinic, P.A. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Smart Clinic · NPI 1699859124
Family Medicine organization in Fairmont, Minnesota. Organization record, active in the CMS NPPES registry since October 24, 2006.
## Identity
- **NPI:** 1699859124 (Entity type: Organization)
- **Enumerated:** October 24, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Legal business name:** Custom Clinic, P.a.
- **Organization subpart:** No
- **Authorized official:** Timothy Bachenberg, PRESIDENT
## Practice location
- **Address:** 322 S STATE ST, 5 LAKE CENTER DRIVE, Fairmont, MN 56031-4139
- **Phone:** (507) 236-2880
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (General Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 22, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1699859124) · Data from the CMS NPPES public registry.