CLEANSLATE MEDICAL GROUP OF WISCONSIN, SC
NPI 1518404854
Internal Medicine - Addiction Medicine in Glendale, WI
NPI Status: Active since January 25, 2017
Contact Information
377 W RIVER WOODS PKWY STE 201
GLENDALE, WI
ZIP 53212
Phone: (413) 323-6880
Fax: (833) 279-7074
- Organization
- Internal Medicine
- Addiction Medicine
- Accepts Insurance
- CLIA Number: 52D2125972
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 02-15-2027
About CLEANSLATE MEDICAL GROUP OF WISCONSIN, SC
This page provides the complete NPI Profile along with additional information for Cleanslate Medical Group Of Wisconsin, Sc, an internist established in Glendale, Wisconsin operating as a Internal Medicine, focusing in addiction medicine . The healthcare provider is registered in the NPI registry with number 1518404854 assigned on January 2017. The practitioner's primary taxonomy code is 207RA0401X. The provider is registered as an organization and their NPI record was last updated one year ago. Cleanslate Medical Group Of Wisconsin, Sc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Matthew Philip Smolarek (Cfo)
- NPI
- 1518404854
- Provider Name
- CLEANSLATE MEDICAL GROUP OF WISCONSIN, SC
- Entity Type
- Organization
- Location Address
- 377 W RIVER WOODS PKWY STE 201 GLENDALE, WI 53212
- Location Phone
- (413) 323-6880
- Location Fax
- (833) 279-7074
- Mailing Address
- 8 CADILLAC DR STE 300 BRENTWOOD, TN 37027
- Mailing Phone
- (615) 425-0220
- Mailing Fax
- (833) 279-7074
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-25-2017
- Last Update Date
- 12-17-2025
- Code Navigator
An internist like Cleanslate Medical Group Of Wisconsin, Sc is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Internal Medicine Addiction Medicine
- Taxonomy Code
- 207RA0401X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Anthem Bronze Pathway/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - HMO
- Anthem Bronze Pathway/Lean HSA (+ Incentives) - HMO
- Anthem Bronze Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Anthem Bronze Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Bronze Preferred/Broad HSA (+ Incentives) - POS
- Anthem Bronze Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Pathway/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Anthem Gold Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- CareSource (Common Ground Healthcare) Bronze $0 Ded / $2500 Rx Ded - EPO
- CareSource (Common Ground Healthcare) Bronze $0 Ded / $2500 Rx Ded - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Bronze $9600 ($45 PCP Copay) - EPO
- CareSource (Common Ground Healthcare) Bronze $9600 ($45 PCP Copay) - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Bronze Standard $7500 - EPO
- CareSource (Common Ground Healthcare) Bronze Standard $7500 - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Gold $0 Ded - EPO
- CareSource (Common Ground Healthcare) Gold $0 Ded - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Gold $3300 - EPO
- CareSource (Common Ground Healthcare) Gold $3300 - Vision Exam - EPO
- Engage by Medica Bronze HSA - EPO
- Engage by Medica Bronze Share - EPO
- Engage by Medica Expanded Bronze Standard - EPO
- Engage by Medica Gold $0 Copay PCP Visits - EPO
- Engage by Medica Gold Share - EPO
- Engage by Medica Gold Standard - EPO
- Engage by Medica Silver $0 Copay PCP Visits - EPO
- Engage by Medica Silver Share - EPO
- Engage by Medica Silver Standard - EPO
- Essentia Choice Care with Medica Bronze HSA - EPO
- MercyCare Bronze 10,000 (1 Free PCP Visit) - HMO
- MercyCare Bronze Standard Expanded - HMO
- MercyCare Gold Standard - HMO
- MercyCare Silver 2,500 (3 Free PCP Visits) - HMO
- MercyCare Silver Health Savings - HMO
- MercyCare Silver Standard - HMO
- Prestige Bronze $0 Medical Deductible - HMO
- Prestige Bronze $0 Medical Deductible + Dental + Vision - HMO
- Prestige Bronze $0 Medical Deductible + Dental +Vision - HMO
- Prestige Bronze Essential + 3 Free PCP Visits - HMO
- Prestige Bronze Essential + Dental + Vision + 3 Free PCP Visits - HMO
- Prestige Bronze Plus - HMO
- Prestige Gold - HMO
- Prestige Gold 50 + 1 Free PCP Visit - HMO
- Prestige Gold 50 + Dental + Vision + 1 Free PCP Visit - HMO
- Prestige Gold 50 + Dental + Vision+ 1 Free PCP Visit - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE $0 MEDICAL DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE $10,150 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE (DENTAL & VISION) $0 MEDICAL DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE (DENTAL & VISION) $10,150 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE (DENTAL & VISION) STANDARD EASY PRICING - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE STANDARD EASY PRICING - HMO
- QUARTZ GUNDERSEN PERFORMANCE CATASTROPHIC $10,600 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE GOLD $4,000 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE GOLD (DENTAL & VISION) $4,000 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE GOLD (DENTAL & VISION) STANDARD EASY PRICING - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 52D2125972
- Facility Type
- Physician Office
- Certificate Effective Date
- February 16, 2025
- Certificate Expiration Date
- February 15, 2027
- Laboratory Director
- DR. ISMAEL ABU LIMON
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Cleanslate Medical Group Of Wisconsin, Sc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1518404854, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 66. The final step is to find the difference between that total and the next multiple of ten (70 - 66 = 4).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 66 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 4 providers are registered at the same or a nearby location.
GLENDALE, WI 53212
GLENDALE, WI 53212
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1518404854, enumerated as an "organization" on January 25, 2017.
The provider is located at 377 W RIVER WOODS PKWY STE 201 GLENDALE, WI 53212 and the phone number is (413) 323-6880.
Internal Medicine with taxonomy code 207RA0401X and a focus in Addiction Medicine.
The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, CareSource. Please consult your insurance carrier or call the provider to verify.
