Organization Active NPI

Ic Professional Services Inc.

  • Family Medicine Physician
  • Miami, FL
National Provider Identifier
1841939758
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
IC PROFESSIONAL SERVICES INC.
Practice address
4995 NW 72ND Ave Ste 201
Miami, FL 33166-5643
Phone
(786) 452-8963
Fax
(305) 675-2727
NPI assigned
May 31, 2022
Last updated
Jun 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

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

Authorized official

Name
Iliana CamejoNPI 1093462418
Title
Owner/Aprn
Phone
(305) 978-2972

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU

Addresses

Primary practice location

4995 NW 72ND Ave Ste 201
Miami, FL 33166-5643

Mailing address

4995 NW 72ND Ave Ste 201
Miami, FL 33166-5643
Phone (786) 452-8963

Other identifiers 1

IdentifierTypeStateIssuer
114503900MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220622002441 FL Part B Supplier - Clinic/Group Practice 1759760770 Receives reassigned benefits from 2 practitioners
Practice locations: Doral, FL

National Provider Directory

National Provider Directory

Locations

4995 NW 72nd Ave
Ste 201
Miami, FL 33166
Phone (786) 452-8963

Practitioners & affiliated clinicians

Practitioners 2

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": "1653955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782777600000",
    "number": "1841939758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4995 NW 72ND AVE STE 201",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331665643",
            "telephone_number": "786-452-8963",
            "fax_number": "305-675-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4995 NW 72ND AVE STE 201",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331665643",
            "telephone_number": "786-452-8963",
            "fax_number": "305-675-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IC PROFESSIONAL SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-31",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A",
        "authorized_official_last_name": "CAMEJO",
        "authorized_official_first_name": "ILIANA",
        "authorized_official_title_or_position": "OWNER/APRN",
        "authorized_official_telephone_number": "305-978-2972"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114503900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; 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.