Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

SASHA RENAE DOMERESE NP-C
NPI 1861956922
Nurse Practitioner in Clarksville, AR

Q: What is Sasha Domerese's NPI number?

The NPI number for Sasha Domerese is 1861956922. It was assigned to this individual provider in the NPPES registry on January 23, 2019. The provider is also known as Sasha Renae Johnson.

Q: What is Sasha Domerese's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Sasha Domerese was last updated on August 11, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 days 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.

Active since January 23, 2019PECOS EnrolledAccepts Medicare Assignment

25 PROFESSIONAL PARK DR, CLARKSVILLE, AR 72830(479) 705-8181(479) 705-0041 Get Directions Write a Review

NPPES record last updated: August 11, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Aug 11, 2026, Apr 8, 2019, Apr 1, 2019 and 1 more (4 updates tracked since 2019).

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About Sasha Renae Domerese Np-c NPPES

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

SASHA RENAE DOMERESE NP-C (NPI 1861956922) is an individual nurse practitioner in Clarksville, Arkansas, licensed in Arkansas (A006062) and active in the NPI registry since January 2019. She is enrolled in Medicare PECOS, maintains a secondary practice location in Clarksville, and is a graduate of Other (2018).

NPPES Registry Identity

NPI1861956922

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameSASHA RENAE DOMERESECredential: NP-C

Location Address25 PROFESSIONAL PARK DRClarksville, AR 72830

Mailing Address25 Professional Park DrClarksville, AR 72830-4432 · (479) 705-8181 · Fax (479) 705-0041

Phone(479) 705-8181

Fax(479) 705-0041

Sole ProprietorNo

Medical School CMSOtherGraduated 2018

Enumeration DateJanuary 23, 2019

Last NPPES UpdateAugust 11, 20264 updates tracked since enumeration

NPPES CertifiedAugust 11, 2026

✔ NPI 1861956922 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in AR · A006062

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedNurse Practitioner · Primary CareTaxonomy 363LP2300X · License A006062 (AR)

25 PROFESSIONAL PARK DR, Clarksville, AR 72830

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Other Names 1

Former Name (1)Sasha Renae Johnson

Secondary Practice Location 1

Location 11100 E Poplar StClarksville, AR 72830-4419 · Phone (479) 754-5454 ext. 400

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Sasha Renae Domerese Np-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5395086482

PECOS Enrollment IDI20190418002055

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 72830 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$79.72 typical visit price

range $51.36 – $157.74

Typical copayment $19.93 (range $12.84 – $39.43)

Most-billed visit code 99203

Established Patient

$91.63 typical visit price

range $16.16 – $128.77

Typical copayment $22.90 (range $4.04 – $32.19)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Face mask interface, replacement for full face mask, each A7031

DME-Other DME · category DE001N

2 suppliers12 claims18 services$38.36 avg. paid by Medicare

Continuous positive airway pressure (cpap) device E0601

DME-Other DME · category DE001N

2 suppliers39 claims39 services$39.47 avg. paid by Medicare

Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds K0823

DME-Wheelchairs · category DD009N

1 supplier11 claims11 services$132.54 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. JESALYN DOVE WILSON PA-C

Physician Assistant