Grace of God Innocent-Utulu

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA17540 Issued in TX

Practice address

6410 Fannin St Ste 370
Houston, TX 77030-3004

Phone

(713) 486-5091

NPI assigned

Jul 7, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ut Physicians

  • Anesthesiology Physician
  • Houston, TX
  • NPI 1033157821

  Physician Assistant

  Medicare reassignment NPD
• Ut Physicians

  dba UT Health Services

  • Health Educator
  • Houston, TX
  • NPI 1316534472
  NPD

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

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1871226639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6410 FANNIN ST STE 370",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770303004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 FANNIN ST STE 370",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770303004",
            "telephone_number": "713-486-5091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INNOCENT-UTULU",
        "first_name": "GRACE OF GOD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-07",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA17540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Innerva Diagnostics
• Innervisions Counseling and Testing
• Innerwisdom
• Innerwisdom Inc.
• Andrew Michael Innes
• Innolife Properties Inc
• Innotech Imaging
• Innova Anesthesia PLLC
• Innova Hospital Houston LP
• Innova Hospital Houston LP Dba Innova Hospital Houston

• Physician Assistant in Houston, TX
• Providers in Houston, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 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; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.