Cleanslate Medical Group of Pennsylvania LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC

Practice address

100 N Wilkes Barre Blvd Ste 103
Wilkes Barre, PA 18702-5240

Phone

(413) 584-2173

Fax

(833) 279-7074

NPI assigned

Jul 26, 2016

Last updated

Aug 26, 2026By the provider in NPPES

Organization subpart

No

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

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 87

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.

• Mark William Bohn, M.D.

  • Addiction Medicine (Preventive Medicine) Physician
  • Scranton, PA
  • NPI 1255668125
  Medicare reassignment Care Compare group NPD
• Marlaina Burns, CRNP

  • Adult Health Nurse Practitioner
  • Scranton, PA
  • NPI 1437552387
  Medicare reassignment Care Compare group NPD
• Kathleen Casterline, L.C.S.W

  • Clinical Social Worker
  • Wilkes Barre, PA
  • NPI 1497153571
  Medicare reassignment Care Compare group NPD
• Angela Delonti, CRNP

  • Family Nurse Practitioner
  • Scranton, PA
  • NPI 1689008880
  Medicare reassignment Care Compare group NPD
• Kimberly Ann Grzybowski, NP-C

  • Family Nurse Practitioner
  • Scranton, PA
  • NPI 1689142283
  Medicare reassignment Care Compare group NPD
• Laurie Elizabeth Healey, FNP-C, MSN-EDU, BSN

  • Family Nurse Practitioner
  • Moosic, PA
  • NPI 1992164065
  Medicare reassignment Care Compare group NPD
• Melissa Hosni, CRNP

  • Nurse Practitioner
  • Allentown, PA
  • NPI 1356047567
  Medicare reassignment Care Compare group NPD
• Amandeep Kaur, CRNP

  • Family Nurse Practitioner
  • Wilkes Barre, PA
  • NPI 1700630316
  Medicare reassignment Care Compare group NPD
• Jill Kissolovege, D.O.

  • Internal Medicine Physician
  • Scranton, PA
  • NPI 1235332263
  Medicare reassignment Care Compare group NPD
• Chelsea Marie Lattieri, NP-C

  • Gerontology Nurse Practitioner
  • Duncansville, PA
  • NPI 1265906903
  Medicare reassignment Care Compare group NPD
• Amber Lynn Leonard, CRNP

  • Nurse Practitioner
  • Williamsport, PA
  • NPI 1295114130
  Medicare reassignment Care Compare group NPD
• Faizmohamed M Mansuri, MD

  • Internal Medicine Physician
  • Moosic, PA
  • NPI 1194756593
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1469491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787702400000",
    "number": "1184177263",
    "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": "100 N WILKES BARRE BLVD STE 103",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187025240",
            "telephone_number": "413-584-2173",
            "fax_number": "833-279-7074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-26",
        "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": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Teresa Clark, RN BSN
• Karen Shepard Clark, RN, MS, CRNP, ACHPN
• Shawn Gerald Clark, D.O.
• Scott Michael Clarke, M.D.
• Margot E. Clasquin, M.D.
• Jacob Clinebell, M.A.
• Stephen Clute
• Michael W Cohen, CRNA
• Erin A. Colarusso, PA-C
• Nicholas Colavito Jr.

• Multi-Specialty Clinic/Center in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Multi-Specialty Clinic/Center in Pennsylvania

• 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.