NPIMap

Organization Active NPI

Premier Pediatrics LLC

  • Pediatrics Physician
  • Dunnellon, FL
National Provider Identifier
1891120960
Registry record updated Jan 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PREMIER PEDIATRICS LLC
Practice address
5388 S US Highway 41
Dunnellon, FL 34432-2042
Phone
(352) 671-6741
Fax
(352) 671-6742
NPI assigned
Sep 9, 2013
Last updated
Jan 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2023

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

Authorized official

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

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

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

Addresses

Primary practice location

5388 S US Highway 41
Dunnellon, FL 34432-2042

Mailing address

7960 SW 60TH Ave Ste 100
Ocala, FL 34476-6457
Phone (352) 671-6741

Other identifiers 2

IdentifierTypeStateIssuer
003198506MedicaidFL
003198508MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131031000618 FL Part A Provider - Rural Health Clinic 5294869236 Practice locations: Dunnellon, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891120960. Details of each certification follow.

Rural health clinic certification: CCN 683812

Legal name
PREMIER PEDIATRICS LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 30, 2014
Last certification
Dec 2, 2025
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Jan 1, 2007 in FL
Enrollment address
5388 S US Highway 41
Dunnellon, FL 34432-2042

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
10D2063523Premier Pediatrics LLC5388 S US Hwy 41, Dunnellon, FL 34432Certificate of waiverAug 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Premier Pediatrics LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

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 Interest Apr 1, 2019 49%
Corporate OfficerVice President Apr 1, 2019 49%
Shahab Eunus Individual 5% Or Greater Direct Ownership Interest Nov 15, 2017 51%
W-2 Managing EmployeePresident Oct 4, 2013

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1378684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674172800000",
    "number": "1891120960",
    "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": "344766457",
            "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": "5388 S US HIGHWAY 41",
            "city": "DUNNELLON",
            "state": "FL",
            "postal_code": "344322042",
            "telephone_number": "352-671-6741",
            "fax_number": "352-671-6742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-09",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A",
        "authorized_official_last_name": "EUNUS",
        "authorized_official_first_name": "SHAHAB",
        "authorized_official_title_or_position": "PRESIDENT",
        "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": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003198506",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003198508",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunnellon, FL

Sources for this page

Verify at the official NPI Registry.