NPIMap

Organization Active NPI

Cleanslate Medical Group of Indiana LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Alexandria, IN
National Provider Identifier
1023464294
Registry record updated Aug 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
Legal business name
CLEANSLATE MEDICAL GROUP OF INDIANA LLC
Practice address
101 N Harrison St
Alexandria, IN 46001-2017
Phone
(765) 233-0903
Fax
(833) 279-7074
NPI assigned
May 6, 2016
Last updated
Aug 26, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul Rogers Anderson
Title
Vice President
Phone
(615) 425-0220

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X
Addiction Medicine (Internal Medicine) Physician 207RA0401X Primary

Addresses

Primary practice location

101 N Harrison St
Alexandria, IN 46001-2017

Mailing address

155 Franklin Rd Ste 430
Brentwood, TN 37027-1602
Phone (615) 425-0220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171023001515 IN Part B Supplier - Clinic/Group Practice 4880963909 Receives reassigned benefits from 115 practitioners
Practice locations: Warsaw, IN; Richmond, IN; Plainfield, IN; Noblesville, IN; Evansville, IN; Muncie, IN; Merrillville, IN; Lafayette, IN…

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

4925 S Scatterfield Rd
#G
Anderson, IN 46013
Phone (765) 442-0402

502 W 2nd St
Ste A
Bloomington, IN 47403
Phone (812) 668-1946

3005 E State Blvd
Fort Wayne, IN 46805
Phone (260) 267-9498

65 Airport Pkwy
Ste 106
Greenwood, IN 46143

65 Airport Pkwy
Ste 114
Greenwood, IN 46143
Phone (317) 807-0268

9660 E Washington St
#300
Indianapolis, IN 46229
Phone (317) 860-5600

30 Professional Ct
Ste 2
Lafayette, IN 47905
Phone (765) 838-1218

8601 Connecticut St
Merrillville, IN 46410
Phone (219) 525-3495

811 Northgate Blvd
New Albany, IN 47150
Phone (502) 287-4100

2302 Chester Blvd
Ste A
Richmond, IN 47374
Phone (765) 488-0345

15 Century Blvd
Ste 307
Nashville, TN 37214
Phone (615) 425-0220

Practitioners & affiliated clinicians

Practitioners 123

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 123

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787702400000",
    "number": "1023464294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 FRANKLIN RD STE 430",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370271602",
            "telephone_number": "615-425-0220",
            "fax_number": "833-279-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N HARRISON ST",
            "city": "ALEXANDRIA",
            "state": "IN",
            "postal_code": "460012017",
            "telephone_number": "765-233-0903",
            "fax_number": "833-279-7074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEANSLATE MEDICAL GROUP OF INDIANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-06",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "ROGERS",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-425-0220"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.