Mariah M. Collicott, NP
NPI 1568185403ActiveIndividual· Nurse Practitioner, Family· Waukesha, WI
Nurse Practitioner, Family (NP) with Cleanslate Medical Group of Wisconsin SC, practicing in Waukesha, Wisconsin. Their prescriptions cost Medicare Part D more than their services did: $31,539 for 479 claims, against $3,437 paid for services in 2024. Orexo US, Inc. reported $20.46 in payments in 2025, mostly food and beverage.
Overview
| NPI | 1568185403 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | NP |
| Sole proprietor | No |
| NPI issued | Sep 26, 2022 |
| Last updated in NPPES | Aug 5, 2025 |
| Certified by provider | Aug 5, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Family Primary | 363LF0000X | 13169-33 | WI |
| Nurse Practitioner | 363L00000X | 13169-33 | WI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Nurse Practitioner (WI) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 45 |
|---|---|
| Services billed | 71 across 15 procedure codes |
| Paid by Medicare | $3,437 |
Part D prescriptions in 2024
| Prescriptions (claims) | 479 · 1,084 30-day fills |
|---|---|
| Patients | 108 |
| Total drug cost | $31,539 |
| Generic share | 91% of claims |
Education and affiliations
| Graduation year | 2022 |
|---|---|
| Medicare specialty | Nurse Practitioner |
| Telehealth | Offers telehealth |
Medical group
- Cleanslate Medical Group of Wisconsin SCKenosha, WI · 24 clinicians
Industry payments (Open Payments)
- 2025$20.46 · 1 payment from 1 company
Top paying companies in 2025
| Company | Amount | Payments |
|---|---|---|
| Orexo US, Inc. | $20.46 | 1 |
What the 2025 payments were for
- Food and Beverage$20.46 · 1 payment
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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