NPIMap

Organization Active NPI

Ira Fialko DO PA

Doing business as Premier Pediatrics Coastal

  • Rural Health Clinic/Center
  • Crystal River, FL
National Provider Identifier
1770865917
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
IRA FIALKO DO PA
Doing business as
Premier Pediatrics Coastal
Practice address
6171 W Gulf to Lake Hwy
Crystal River, FL 34429-2679
Phone
(352) 563-0220
Fax
(352) 563-0706
NPI assigned
Sep 14, 2011
Last updated
Sep 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shahab Eunus, MDNPI 1619085610
Title
Owner
Phone
(352) 671-6741

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Pediatrics Physician 208000000X NU
General Practice Physician 208D00000X NU

Addresses

Primary practice location

6171 W Gulf to Lake Hwy
Crystal River, FL 34429-2679

Mailing address

7960 SW 60TH Ave Ste 100
Ocala, FL 34476-6409
Phone (352) 671-6741

Other identifiers 8

IdentifierTypeStateIssuer
202840OtherGASTAYWELL
046778200MedicaidFL
121610464236OtherFLHUMANA
267066600OtherFLFLORIDA MEDICAID GROUP #
202840OtherFLHEALTHEASE
82630OtherFLBCBS OF FLORIDA
01118033OtherFLAMERIGROUP
366272OtherFLMEDICARE

Other names 1

  • Premier Pediatrics Coastal Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111109000357 FL Part A Provider - Rural Health Clinic 6305019233 Practice locations: Crystal River, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770865917. Details of each certification follow.

Rural health clinic certification: CCN 103848

Legal name
IRA FIALKO DO PA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 4, 1993
Last certification
Sep 9, 2020
Ownership / control type
1B
Most recent change of ownership
Aug 1, 2011 (1 total)
Organization structure
CorporationProprietary
Incorporated
Feb 6, 1992 in FL
Enrollment address
6171 West Gulf to Lake Highway
Crystal River, FL 34429-2679

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0672644Ira Fialko DO6171 W Gulf to Lake Hwy, Crystal River, FL 34429Certificate of waiverApr 25, 2028

National Provider Directory

National Provider Directory

Locations

6171 W Gulf To Lake Hwy
Crystal River, FL 34429
Phone (352) 563-0220

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Svetlana Y Rogozina Individual 5% Or Greater Direct Ownership InterestVP Jan 1, 2023 50%
Corporate OfficerVP Jan 1, 2023 50%
W-2 Managing EmployeeVP Jan 1, 2023 50%
Linda Christensen Individual W-2 Managing Employee Aug 1, 2011
Shahab Eunus Individual 5% Or Greater Direct Ownership Interest Jan 1, 2023 50%
Corporate OfficerPresident Jan 1, 2023 50%
W-2 Managing EmployeePresident Jan 1, 2023 50%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Svetlana Rogozina, MD
    • Internal Medicine Physician
    • Ocala, FL
    • NPI 1568576437

    5% Or Greater Direct Ownership Interest, Corporate Officer, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1770865917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7960 SW 60TH AVE STE 100",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344766409",
            "telephone_number": "352-671-6741",
            "fax_number": "352-671-6742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6171 W GULF TO LAKE HWY",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344292679",
            "telephone_number": "352-563-0220",
            "fax_number": "352-563-0706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRA FIALKO DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-14",
        "last_updated": "2025-09-02",
        "certification_date": "2025-05-22",
        "status": "A",
        "authorized_official_last_name": "EUNUS",
        "authorized_official_first_name": "SHAHAB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-671-6741",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STAYWELL",
            "identifier": "202840",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046778200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "121610464236",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA MEDICAID GROUP #",
            "identifier": "267066600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHEASE",
            "identifier": "202840",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "82630",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01118033",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "366272",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Pediatrics Coastal",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crystal River, FL

Sources for this page

Verify at the official NPI Registry.