Physician Compare National (NPI:1093799603)

HEALTHCARE PROVIDER: TIMOTHY BACHENBERG MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1093799603
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1951214626
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20041123000186
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BACHENBERG
	Individual professional last name
Provider First Name	TIMOTHY
	Individual professional first name
Provider Middle Name	C
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	MAYO MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1990
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	EMERGENCY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	EMERGENCY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	829 N N AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 3
	Group Practice or individual's line 2 address
City	FAIRMONT
	Group Practice or individual's city
State	MN
	Group Practice or individual's state
Zip Code	56031
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	240166
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MAYO CLINIC HEALTH SYSTEM - FAIRMONT
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	241369
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	UNITED HOSPITAL DISTRICT
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	241333
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MAYO CLINIC HEALTH SYSTEM - ST JAMES
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	M