NPI: 1376178129 · GILBERT, AZ 85234 · Multi-Specialty Clinic/Center · NPI assigned 03/11/2020
| Authorized Official | SMOLAREK, MATTHEW (CFO) |
| NPI Enumeration Date | 03/11/2020 |
Other providers sharing the same authorized official: SMOLAREK, MATTHEW
| Provider | City | State | Total Paid |
|---|---|---|---|
| CLEANSLATE MEDICAL GROUP OF INDIANA LLC | ALEXANDRIA | IN | $79.21M |
| TOTAL WELLNESS CENTERS, LLC | HOLYOKE | MA | $77.17M |
| TOTAL WELLNESS CENTERS, LLC | WEST SPRINGFIELD | MA | $38.42M |
| CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC | WILKES BARRE | PA | $18.61M |
| CLEANSLATE MEDICAL GROUP OF WISCONSIN, SC | GLENDALE | WI | $17.13M |
| CLEANSLATE MEDICAL GROUP OF KENTUCKY PLLC | LOUISVILLE | KY | $10.48M |
| CLEANSLATE MEDICAL GROUP OF OHIO LLC | MORAINE | OH | $9.53M |
| CLEANSLATE MEDICAL GROUP OF VIRGINIA, LLC | MECHANICSVILLE | VA | $4.28M |
| CLEANSLATE MEDICAL GROUP OF ARIZONA PLLC | PHOENIX | AZ | $248K |
| CLEANSLATE MEDICAL GROUP OF ARIZONA PLLC | PHOENIX | AZ | $101K |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 1,408 | $56K |
| 2022 | 5,973 | $316K |
| 2023 | 4,334 | $241K |
| 2024 | 6,159 | $342K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | 9,004 | 5,233 | $475K |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 4,248 | 2,639 | $249K |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 3,168 | 2,335 | $129K |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed | 944 | 812 | $93K |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | 91 | 88 | $2K |
| 90837 | Psychotherapy, 53 minutes with patient | 19 | 12 | $2K |
| 90832 | Psychotherapy, 30 minutes with patient | 42 | 36 | $2K |
| 81025 | 211 | 202 | $1K | |
| 86803 | 73 | 70 | $951.16 | |
| 87340 | 74 | 74 | $747.53 |