NPIMap

Organization Active NPI

Initium Novum LLC

  • Public Health & General Preventive Medicine Physician
  • Miami, FL
National Provider Identifier
1346809290
Registry record updated Jun 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X
Legal business name
INITIUM NOVUM LLC
Practice address
1657 N Miami Ave Apt 515
Miami, FL 33136-2010
Phone
(310) 367-7517
NPI assigned
Jun 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2019

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

Authorized official

Name
Terrence Valentino Bailey, EXERCISEPHYSIOLOGIST
Title
Director of Human Performance
Phone
(310) 367-7517

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health & General Preventive Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0901X Primary
Public Health or Welfare Agency 251K00000X
Community Health Clinic/Center 261QC1500X
Corporate Health Clinic/Center 261QC1800X
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

1657 N Miami Ave Apt 515
Miami, FL 33136-2010

Mailing address

1657 N Miami Ave Apt 515
Miami, FL 33136-2010
Phone (310) 367-7517

Other names 1

  • Venom Performance Training Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560297600000",
    "number": "1346809290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1657 N MIAMI AVE APT 515",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331362010",
            "telephone_number": "310-367-7517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1657 N MIAMI AVE APT 515",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331362010",
            "telephone_number": "310-367-7517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INITIUM NOVUM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-12",
        "last_updated": "2019-06-12",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "TERRENCE",
        "authorized_official_middle_name": "VALENTINO",
        "authorized_official_title_or_position": "DIRECTOR OF HUMAN PERFORMANCE",
        "authorized_official_telephone_number": "310-367-7517",
        "authorized_official_credential": "EXERCISEPHYSIOLOGIST"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Corporate Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Venom Performance Training",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.