NPIMap

Organization Active NPI

Interamerican Medical Center Group LLC

Doing business as IMC Health

  • Family Medicine Physician
  • Miami Lakes, FL
National Provider Identifier
1417236019
Registry record updated Aug 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
INTERAMERICAN MEDICAL CENTER GROUP LLC
Doing business as
IMC Health
Practice address
15529 Bull Run Rd
Miami Lakes, FL 33014-7004
Phone
(305) 455-3200
Fax
(305) 455-3202
NPI assigned
Aug 12, 2011
Last updated
Aug 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2024

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

Authorized official

Name
Carlos De Solo
Title
Chief Executive Officer
Phone
(305) 649-8100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

15529 Bull Run Rd
Miami Lakes, FL 33014-7004

Mailing address

1000 NW 57TH CT Ste 400
Miami, FL 33126-3292
Phone (305) 649-8100

Other names 1

  • IMC Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110415000674 FL Part B Supplier - Clinic/Group Practice 2961686951 Receives reassigned benefits from 73 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Homestead, FL; Orlando, FL; Miami Lakes, FL; Miami, FL; Lauderhill, FL; Hialeah, FL

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1313107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723680000000",
    "number": "1417236019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 NW 57TH CT STE 400",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263292",
            "telephone_number": "305-649-8100",
            "fax_number": "305-649-8778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15529 BULL RUN RD",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330147004",
            "telephone_number": "305-455-3200",
            "fax_number": "305-455-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERAMERICAN MEDICAL CENTER GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-12",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A",
        "authorized_official_last_name": "DE SOLO",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "305-649-8100"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMC Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Miami Lakes, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.