NPIMap

Organization Active NPI

Cleanslate Medical Group of Virginia, LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Mechanicsville, VA
National Provider Identifier
1629549779
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
Legal business name
CLEANSLATE MEDICAL GROUP OF VIRGINIA, LLC
Practice address
8220 Meadowbridge Rd Ste 310
Mechanicsville, VA 23116-2340
Phone
(804) 417-0120
Fax
(804) 277-3029
NPI assigned
Dec 16, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Authorized official

Name
Matthew Philip Smolarek
Title
Cfo
Phone
(412) 999-5188

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X Primary

Addresses

Primary practice location

8220 Meadowbridge Rd Ste 310
Mechanicsville, VA 23116-2340

Mailing address

8 Cadillac Dr Ste 180
Brentwood, TN 37027-5393
Phone (615) 425-0220

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1510 N 28th St
Ste 101
Richmond, VA 23223
Phone (804) 371-1670

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1629549779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 CADILLAC DR STE 180",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275393",
            "telephone_number": "615-425-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8220 MEADOWBRIDGE RD STE 310",
            "city": "MECHANICSVILLE",
            "state": "VA",
            "postal_code": "231162340",
            "telephone_number": "804-417-0120",
            "fax_number": "804-277-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEANSLATE MEDICAL GROUP OF VIRGINIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A",
        "authorized_official_last_name": "SMOLAREK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "PHILIP",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "412-999-5188"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mechanicsville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.