PREMIER DERMATOLOGY & SKIN RENEWAL CENTER
NPI 1912912361
Dermatology - Clinical & Laboratory Dermatological Immunology in Bentonville, AR
NPI Status: Active since July 31, 2006
Contact Information
909 SE 28TH ST
STE 5
BENTONVILLE, AR
ZIP 72712
Phone: (479) 273-3376
Fax: (479) 273-3468
- Organization
- Dermatology
- Clinical & Laboratory Dermatological Imm...
- CLIA Number: 04D1034085
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 08-22-2027
About PREMIER DERMATOLOGY & SKIN RENEWAL CENTER
This page provides the complete NPI Profile along with additional information for Premier Dermatology & Skin Renewal Center, a provider established in Bentonville, Arkansas operating as a Dermatology, focusing in clinical & laboratory dermatological immunology . The healthcare provider is registered in the NPI registry with number 1912912361 assigned on July 2006. The practitioner's primary taxonomy code is 207NI0002X. The provider is registered as an organization and their NPI record was last updated one year ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Mr. Jeff Clifton (Coo)
- NPI
- 1912912361
- Provider Name
- PREMIER DERMATOLOGY & SKIN RENEWAL CENTER
- Entity Type
- Organization
- Location Address
- 909 SE 28TH ST STE 5 BENTONVILLE, AR 72712
- Location Phone
- (479) 273-3376
- Location Fax
- (479) 273-3468
- Mailing Address
- 909 SE 28TH ST STE 5 BENTONVILLE, AR 72712
- Mailing Phone
- (479) 273-3376
- Mailing Fax
- (479) 273-3468
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 07-31-2006
- Last Update Date
- 09-11-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dermatology Clinical & Laboratory Dermatological Immunology
- Taxonomy Code
- 207NI0002X
- Type
- Allopathic & Osteopathic Physicians
- License State
- AR
- Taxonomy Description
- A dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the body's immune system. Immunodermatologists also may provide consultation in the management of these disorders and administer specialized forms of therapy for these diseases.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | E3363 (AR) |
| 2 | 207NP0225X | Allopathic & Osteopathic Physicians | Dermatology | E3363 (AR) |
| 3 | 207NS0135X | Allopathic & Osteopathic Physicians | Dermatology | E3363 (AR) |
Group Taxonomy 193400000X MULTIPLE SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1679521405 | OTHER (01) | AR | NPI - MILDRED CLIFTON, MD |
| 03060015000 | OTHER (01) | AR | QUALCHOICE |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 04D1034085
- Facility Type
- Physician Office
- Certificate Effective Date
- August 23, 2025
- Certificate Expiration Date
- August 22, 2027
- Laboratory Director
- DR. LAURA R. BATTLE
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Premier Dermatology & Skin Renewal Center after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1912912361, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 59. The final step is to find the difference between that total and the next multiple of ten (60 - 59 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 59 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
BENTONVILLE, AR 72712
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1912912361, enumerated as an "organization" on July 31, 2006.
The provider is located at 909 SE 28TH ST STE 5 BENTONVILLE, AR 72712 and the phone number is (479) 273-3376.
Dermatology with taxonomy code 207NI0002X and a focus in Clinical & Laboratory Dermatological Immunology.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
