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REVIVAL DERMATOLOGY PLLC
NPI 1679149702
Dermatology in Dallas, TX

Active since May 30, 2021CLIA 45D2233097 · Microscopy
8201 PRESTON RD STE 440, DALLAS, TX 75225(214) 675-3227(972) 435-4481 Get Directions Write a Review

NPPES record last updated: June 11, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 11, 2021, May 30, 2021 (2 updates tracked since 2021).

About Revival Dermatology Pllc NPPES

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

REVIVAL DERMATOLOGY PLLC (NPI 1679149702) is a healthcare organization registered as a dermatology in Dallas, Texas and active in the NPI registry since May 2021. The organization holds a CLIA Microscopy certificate valid through August 18, 2027 and lists Lisa Guidry Pruett, President, as its authorized official.

NPPES Registry Identity

NPI1679149702
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameREVIVAL DERMATOLOGY PLLC
Location Address8201 PRESTON RD STE 440Dallas, TX 75225-6209
Mailing Address8201 Preston Rd Ste 440Dallas, TX 75225-6209 · (214) 675-3227
Phone(214) 675-3227
Fax(972) 435-4481
Organization SubpartNo
Authorized OfficialLisa Guidry PruettPresident · (504) 319-1407
Enumeration DateMay 30, 2021
Last NPPES UpdateJune 11, 20212 updates tracked since enumeration
NPPES CertifiedJune 11, 2021
✔ NPI 1679149702 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.
8201 PRESTON RD STE 440, Dallas, TX 75225
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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)

Revival Dermatology 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 Revival Dermatology PLLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

Lisa Guidry Pruett, MD
Dermatology
NPI 1356367106
8201 PRESTON RD STE 440
Dallas, TX 75225
(214) 675-3227
✔ PECOS✔ Accepts MedicareSame address
Jon Pruett, M.D.
Dermatology
NPI 1023071933
8201 PRESTON RD STE 440
Dallas, TX 75225
(214) 675-3227
✔ PECOS✔ Accepts MedicareSame address
Amanda Champlain, M.D.
Dermatology
NPI 1003180993
4685 ELDORADO PKWY STE 100
Frisco, TX 75033
(972) 335-2727
✔ PECOS✔ Accepts Medicare22 mi

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

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) 45D2233097

Revival Dermatology PLLC · Dallas, TX
Active · expires Aug 18, 2027
CLIA Number45D2233097
Laboratory TypePhysician Office
Certificate Effective DateAugust 19, 2025
Certificate Expiration DateAugust 18, 2027
Laboratory DirectorLisa Guidry Pruett
Laboratory Phone(216) 675-3227
Laboratory LocationRevival Dermatology PLLC8201 Preston Rd Ste 440, Dallas, TX 75225
CLIA data matches this NPI record on: Address Name
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 Revival Dermatology PLLC's NPI number?

The NPI number for Revival Dermatology PLLC is 1679149702. It was assigned to this organization in the NPPES registry on May 30, 2021.

Where is Revival Dermatology PLLC located?

Revival Dermatology PLLC is located at 8201 Preston Rd Ste 440, Dallas, TX 75225. The listed phone number is (214) 675-3227.

What is Revival Dermatology PLLC's specialty?

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

Is Revival Dermatology PLLC enrolled in Medicare?

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

How many clinicians bill Medicare through Revival Dermatology PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Dermatology, reassign their Medicare billing to Revival Dermatology PLLC. 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, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Revival Dermatology PLLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 45D2233097) is associated with this NPI, valid through August 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Revival Dermatology PLLC was last updated on June 11, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.