CLEANSLATE MEDICAL GROUP OF OHIO LLC
NPI 1558800193
Internal Medicine - Addiction Medicine in Moraine, OH

Q: What is Cleanslate Medical Group Of Ohio LLC's NPI number?

The NPI number for Cleanslate Medical Group Of Ohio LLC is 1558800193. It was assigned to this organization in the NPPES registry on February 15, 2017.

Q: What is Cleanslate Medical Group Of Ohio LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Addiction Medicine, with taxonomy code 207RA0401X.

Active since February 15, 2017

4700 SPRINGBORO PIKE STE C, MORAINE, OH 45439(937) 558-5100(833) 279-7074 Get Directions Write a Review

NPPES record last updated: August 26, 2026. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Aug 26, 2026, Dec 17, 2025, May 8, 2025 and 4 more (7 updates tracked since 2017).

On this page

About Cleanslate Medical Group Of Ohio Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLEANSLATE MEDICAL GROUP OF OHIO LLC (NPI 1558800193) is a healthcare organization registered as an addiction medicine in Moraine, Ohio and active in the NPI registry since February 2017. The organization lists Paul Rogers Anderson, Vice President, as its authorized official.

NPPES Registry Identity

NPI1558800193

Entity TypeOrganization

Primary Taxonomy207RA0401X

Legal Business NameCLEANSLATE MEDICAL GROUP OF OHIO LLC

Location Address4700 SPRINGBORO PIKE STE CMoraine, OH 45439-1982

Mailing Address155 Franklin Rd Ste 430Brentwood, TN 37027-1602 · (615) 425-0220 · Fax (833) 279-7074

Phone(937) 558-5100

Fax(833) 279-7074

Organization SubpartNo

Authorized OfficialPaul Rogers AndersonVice President · (615) 425-0220

Enumeration DateFebruary 15, 2017

Last NPPES UpdateAugust 26, 20267 updates tracked since enumeration

NPPES CertifiedAugust 26, 2026

✔ NPI 1558800193 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Addiction MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207RA0401X

Definition

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.

4700 SPRINGBORO PIKE STE C, Moraine, OH 45439

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.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 Ohio Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 9 clinicians reassign Medicare billing to Cleanslate Medical Group Of Ohio LLC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (9)

Franklin Wylie, LICDC-CS, ICCS

Mental Health Counselor

NPI 1538435151

1 ELIZABETH PL
Dayton, OH 45417

(937) 813-1737

6.1 mi

Kimberly Titus, APRN-CNP

Nurse Practitioner

NPI 1265011944

1416 W 1ST ST
Springfield, OH 45504

(937) 521-8150

✔ PECOS27 mi

Marcia Stephens, NP

Nurse Practitioner

NPI 1699192955

10999 REED HARTMAN HWY STE 215
Blue Ash, OH 45242

(513) 745-9320

✔ PECOS30 mi

Patina Nelson, LCDCIII

Mental Health Counselor

NPI 1184121303

311 MARTIN LUTHER KING DR W
Cincinnati, OH 45220

(513) 475-5800

✔ PECOS41 mi

Veronica Bellamy, LICDC 161589

Mental Health Counselor

NPI 1437651346

1580 STATE ROUTE 56 SW
London, OH 43140

(740) 852-2454

✔ PECOS41 mi

Taylor Chiller, APRN, FNP-C

Nurse Practitioner

NPI 1023778149

7410 BEECHMONT AVE
Cincinnati, OH 45255

(330) 931-0754

✔ PECOS43 mi

Anitra Niece, RN

Nurse Practitioner

NPI 1023606944

3654 WERK RD
Cincinnati, OH 45248

(513) 452-0929

✔ PECOS44 mi

Kate Berenson, M.D.

Addiction Medicine

NPI 1619266582

290 E TOWN ST
Columbus, OH 43215

(614) 788-5400

✔ PECOS68 mi

Satkiran Grewal, M.D.

Addiction Medicine

NPI 1356421085

900 MEMORIAL AVE
West Springfield, MA 01089

(413) 788-0100

✔ PECOS629 mi

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 Ohio LLC's NPI number?

The NPI number for Cleanslate Medical Group Of Ohio LLC is 1558800193. It was assigned to this organization in the NPPES registry on February 15, 2017.

Where is Cleanslate Medical Group Of Ohio LLC located?

Cleanslate Medical Group Of Ohio LLC is located at 4700 Springboro Pike Ste C, Moraine, OH 45439. The listed phone number is (937) 558-5100.

What is Cleanslate Medical Group Of Ohio LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Addiction Medicine, with taxonomy code 207RA0401X.

Is Cleanslate Medical Group Of Ohio LLC enrolled in Medicare?

Yes. Cleanslate Medical Group Of Ohio LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Cleanslate Medical Group Of Ohio LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 9 clinicians in 3 Medicare specialties reassign their Medicare billing to Cleanslate Medical Group Of Ohio 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 (4), Mental Health Counselor (3) and Addiction Medicine (2). Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Cleanslate Medical Group Of Ohio LLC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, AmeriHealth Caritas Next and Anthem Blue Cross and Blue Shield list Cleanslate Medical Group Of Ohio 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 Ohio 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.