NPIMap

Organization Active NPI

Premier Pediatrics, LLC

Doing business as Premier Pediatrics - Anthony

  • Rural Health Clinic/Center
  • Anthony, FL
National Provider Identifier
1942006853
Registry record updated Feb 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PREMIER PEDIATRICS, LLC
Doing business as
Premier Pediatrics - Anthony
Practice address
2040 NE 95TH St
Anthony, FL 32617-3628
Phone
(352) 509-5082
Fax
(352) 509-5083
NPI assigned
Feb 21, 2025
Last updated
Feb 21, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PREMIER PEDIATRICS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 21, 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) 509-5082

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Pediatrics Physician 208000000X NU
General Practice Physician 208D00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2040 NE 95TH St
Anthony, FL 32617-3628

Mailing address

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

Other names 1

  • Premier Pediatrics - Anthony Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250519001644 FL Part A Provider - Rural Health Clinic 5294869236 Practice locations: Anthony, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942006853. Details of each certification follow.

Rural health clinic certification: CCN 683852

Legal name
PREMIER PEDIATRICS LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 9, 2025
Last certification
Sep 9, 2025
Ownership / control type
1C
Organization structure
LLCProprietary
Enrollment address
2040 NE 95TH St
Anthony, FL 32617-3628

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
10D2321646Premier Pediatrics LLC2040 NE 95TH St, Anthony, FL 32617Certificate of waiverApr 7, 2027

National Provider Directory

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

Other organizations with this tax ID 6

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

Locations

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

14141 E Highway 40
Ste B
Silver Springs, FL 34488
Phone (352) 512-0466

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 InterestVice President Jan 1, 2007 50%
Corporate OfficerVice President Jan 1, 2007 50%
Operational/Managerial ControlVice President Jan 1, 2007 50%
Shahab Eunus Individual 5% Or Greater Direct Ownership InterestPresident Jan 1, 2007 50%
Corporate OfficerPresident Jan 1, 2007 50%
W-2 Managing EmployeePresident Jan 1, 2007 50%
Operational/Managerial ControlPresident Jan 1, 2007 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, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1740096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740096000000",
    "number": "1942006853",
    "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": "2040 NE 95TH ST",
            "city": "ANTHONY",
            "state": "FL",
            "postal_code": "326173628",
            "telephone_number": "352-509-5082",
            "fax_number": "352-509-5083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PEDIATRICS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIER PEDIATRICS LLC",
        "enumeration_date": "2025-02-21",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "status": "A",
        "authorized_official_last_name": "EUNUS",
        "authorized_official_first_name": "SHAHAB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-509-5082",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "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
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Pediatrics - Anthony",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anthony, FL

Sources for this page

Verify at the official NPI Registry.