CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC
NPI 1184177263
Clinic/Center - Multi-Specialty in Wilkes Barre, PA
About Cleanslate Medical Group Of Pennsylvania Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC (NPI 1184177263) is a healthcare organization registered as a multi-specialty in Wilkes Barre, Pennsylvania and active in the NPI registry since July 2016. The organization lists Paul Rogers Anderson, Vice President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Cleanslate Medical Group Of Pennsylvania Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
22Medicare enrollment records show 22 clinicians reassign Medicare billing to Cleanslate Medical Group Of Pennsylvania LLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 7 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 7
Nearest to this location (20)
See all 22Wilkes Barre, PA 18702
Wilkes Barre, PA 18702
Wilkes Barre, PA 18702
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 Cleanslate Medical Group Of Pennsylvania LLC's NPI number?
The NPI number for Cleanslate Medical Group Of Pennsylvania LLC is 1184177263. It was assigned to this organization in the NPPES registry on July 26, 2016.
Where is Cleanslate Medical Group Of Pennsylvania LLC located?
Cleanslate Medical Group Of Pennsylvania LLC is located at 100 N Wilkes Barre Blvd Ste 103, Wilkes Barre, PA 18702. The listed phone number is (413) 584-2173.
What is Cleanslate Medical Group Of Pennsylvania LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.
Is Cleanslate Medical Group Of Pennsylvania LLC enrolled in Medicare?
Yes. Cleanslate Medical Group Of Pennsylvania LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Cleanslate Medical Group Of Pennsylvania LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 22 clinicians in 7 Medicare specialties reassign their Medicare billing to Cleanslate Medical Group Of Pennsylvania LLC. 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. The largest specialties are Nurse Practitioner (15), Internal Medicine (2) and Addiction Medicine (1). Of these, 3 practice at this address and 7 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Cleanslate Medical Group Of Pennsylvania LLC accept?
Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Buckeye Health Plan and CareSource list Cleanslate Medical Group Of Pennsylvania LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Cleanslate Medical Group Of Pennsylvania LLC was last updated on August 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.
# Cleanslate Medical Group Of Pennsylvania Llc · NPI 1184177263
Multi-Specialty organization in Wilkes Barre, Pennsylvania. Organization record, active in the CMS NPPES registry since July 26, 2016.
## Identity
- **NPI:** 1184177263 (Entity type: Organization)
- **Enumerated:** July 26, 2016
- **Primary specialty:** Clinic/Center - Multi-Specialty · taxonomy 261QM1300X
- **Organization subpart:** No
- **Authorized official:** Paul Anderson, VICE PRESIDENT
## Practice location
- **Address:** 100 N WILKES BARRE BLVD STE 103, Wilkes Barre, PA 18702-5240
- **Phone:** (413) 584-2173 · **Fax:** (833) 279-7074
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 22 clinicians in 7 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (15), Internal Medicine (2), Addiction Medicine (1); 3 practice at this address and 7 within 10 miles; [full list](https://npiprofile.com/npi/1184177263/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 26, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1184177263) · Data from the CMS NPPES public registry.