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PREMIER DERMATOLOGY SERVICES PLLC
NPI 1154117463
Dermatology in Bentonville, AR

Active since April 15, 2025CLIA Certified · 3 labs
901 SE PLAZA AVE STE 5, BENTONVILLE, AR 72712(479) 273-3376(479) 273-3468 Get Directions Write a Review

NPPES record last updated: June 24, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Premier Dermatology Services Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PREMIER DERMATOLOGY SERVICES PLLC (NPI 1154117463), doing business as Premier Dermatology & Aesthetics, is a healthcare organization registered as a dermatology in Bentonville, Arkansas and active in the NPI registry since April 2025. The organization holds 3 active CLIA laboratory certificates, maintains 2 additional practice locations, and lists Sara Fast, Practice Director, as its authorized official.

NPPES Registry Identity

NPI1154117463
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NamePREMIER DERMATOLOGY SERVICES PLLC
Location Address901 SE PLAZA AVE STE 5Bentonville, AR 72712-5473
Mailing Address901 Se Plaza Ave Ste 5Bentonville, AR 72712-5473 · (479) 273-3376 · Fax (479) 273-3468
Phone(479) 273-3376
Fax(479) 273-3468
Organization SubpartNo
Authorized OfficialSara FastPractice Director · (479) 876-8501
Enumeration DateApril 15, 2025
Last NPPES UpdateJune 24, 2026
NPPES CertifiedJune 24, 2026
✔ NPI 1154117463 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
901 SE PLAZA AVE STE 5, Bentonville, AR 72712
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Other Names 1

Doing Business AsPremier Dermatology & Aesthetics

Secondary Practice Locations 2

Location 11702 SE 8th St Ste 10Bentonville, AR 72712-2891 · Phone (479) 273-3376
Location 25691 Gateway Ave, Suite DSpringdale, AR 72762 · Phone (479) 273-3376

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Premier Dermatology Services Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Premier Dermatology Services PLLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

Mildred Clifton, M.D.
Dermatology
NPI 1679521405
901 SE PLAZA AVE STE 5
Bentonville, AR 72712
(479) 273-3376
✔ PECOS✔ Accepts MedicareSame address
Cheri Cunningham, M.D
Dermatology
NPI 1326492869
901 SE PLAZA AVE STE 5
Bentonville, AR 72712
(479) 273-3376
✔ PECOS✔ Accepts MedicareSame address
Savannah Rosamond
Nurse Practitioner
NPI 1265201230
901 SE PLAZA AVE STE 5
Bentonville, AR 72712
(479) 273-3376
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 04D2332438

Premier Dermatology Services PLLC · Bentonville, AR
Active · expires Jul 31, 2028
CLIA Number04D2332438
Laboratory TypePhysician Office
Certificate Effective DateAugust 1, 2026
Certificate Expiration DateJuly 31, 2028
Laboratory DirectorMildred M. Clifton
Laboratory Phone(479) 273-3376
Laboratory LocationPremier Dermatology Services PLLC901 SE Plaza Ave, Ste 5, Bentonville, AR 72712
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 04D2346233

Premier Dermatology Services PLLC · Springdale, AR
Active · expires Jun 25, 2028
CLIA Number04D2346233
Laboratory TypePhysician Office
Certificate Effective DateJune 26, 2026
Certificate Expiration DateJune 25, 2028
Laboratory DirectorDr. Mildred M. Clifton
Laboratory Phone(479) 273-3376
Laboratory LocationPremier Dermatology Services PLLC5691 Gateway Ave Suite D, Springdale, AR 72762
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 04D2346236

Premier Dermatology Services PLLC · Bentonville, AR
Active · expires Jun 25, 2028
CLIA Number04D2346236
Laboratory TypePhysician Office
Certificate Effective DateJune 26, 2026
Certificate Expiration DateJune 25, 2028
Laboratory DirectorDr. Mildred M. Clifton
Laboratory Phone(479) 273-3376
Laboratory LocationPremier Dermatology Services PLLC1702 SE 8th Street Suite 10, Bentonville, AR 72712
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Premier Dermatology Services PLLC's NPI number?

The NPI number for Premier Dermatology Services PLLC is 1154117463. It was assigned to this organization in the NPPES registry on April 15, 2025. The provider is doing business as Premier Dermatology & Aesthetics.

Where is Premier Dermatology Services PLLC located?

Premier Dermatology Services PLLC is located at 901 SE Plaza Ave Ste 5, Bentonville, AR 72712. The listed phone number is (479) 273-3376.

What is Premier Dermatology Services PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Premier Dermatology Services PLLC enrolled in Medicare?

Yes. Premier Dermatology Services PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Premier Dermatology Services PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Premier Dermatology Services PLLC, in Dermatology and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Premier Dermatology Services PLLC hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Premier Dermatology Services PLLC was last updated on June 24, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.