NPIMap

Organization Active NPI

Cleanslate Medical Group of Arizona PLLC

  • Multi-Specialty Clinic/Center
  • Gilbert, AZ
National Provider Identifier
1376178129
Registry record updated Aug 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
CLEANSLATE MEDICAL GROUP OF ARIZONA PLLC
Practice address
2451 E Baseline Rd Ste 430
Gilbert, AZ 85234-2473
Phone
(602) 313-4391
Fax
(833) 279-7074
NPI assigned
Mar 11, 2020
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

2451 E Baseline Rd Ste 430
Gilbert, AZ 85234-2473

Mailing address

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

Other names 1

  • Cleanslate Centers- Gilbert, AZ. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170515001155 AZ Part B Supplier - Clinic/Group Practice 6901183235 Receives reassigned benefits from 9 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gilbert, AZ; Phoenix, AZ

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2126963Cleanslate Centers2451 E Baseline Rd, #430, Gilbert, AZ 85234Certificate of waiverMar 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cleanslate Medical Group of Arizona PLLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

59 Bobala Rd
Holyoke, MA 01040
Phone (413) 486-7819

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1583884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787702400000",
    "number": "1376178129",
    "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": "2451 E BASELINE RD STE 430",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342473",
            "telephone_number": "602-313-4391",
            "fax_number": "833-279-7074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEANSLATE MEDICAL GROUP OF ARIZONA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-11",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cleanslate Centers- Gilbert, AZ.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gilbert, AZ

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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.