Koushik Prudvi Kasanagottu, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

186556 Issued in CA

Practice address

5379 Hamner Ave Unit 801
Eastvale, CA 91752-1042

Phone

(888) 854-1397

NPI assigned

Jun 6, 2018

Last updated

Nov 26, 2025By the provider in NPPES

Sex

Male

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 CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Beaver Medical Group P CGroup PAC ID 0547164295, 251 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Med Care Plus Home Health Inc Home health agency, Pasadena, CA, CCN 058155

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: kkkasanagottu22940@epiclp.direct-ci.com
• Direct secure messaging: koushik.kasanagottu@49412312072196.direct.elationemr.com

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

• Beaver Medical Group P C

  dba Optum

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1649503319

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Healthcare Partners Affiliates Medical Group

  dba Optum

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1659312593
  Medicare reassignment NPD
• Beaver Medical Group P C

  • Physical Therapist
  • Redlands, CA
  • NPI 1427090281
  NPD
• Cassidy Medical Group Inc.

  • Multi-Specialty Clinic/Center
  • Vista, CA
  • NPI 1215003470
  NPD
• Centers for Family Medicine GP

  dba Optumcare Medical Group

  • Family Medicine Physician
  • Los Alamitos, CA
  • NPI 1467598243

  Internal Medicine

  NPD
• Healthcare Partners Affiliates Medical Group

  dba Optum

  • Durable Medical Equipment & Medical Supplies
  • Murrieta, CA
  • NPI 1760057269
  NPD
• Beaver Medical Group P C

  dba Beaver Advantage Health Center

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1275570830

  Internal Medicine

  NPD (past)
• Loma Linda University Medical Center

  • General Acute Care Hospital
  • Loma Linda, CA
  • NPI 1194731935
  NPD (past)
• Pinnacle Medical Group, Inc.

  • Family Medicine Physician
  • San Bernardino, CA
  • NPI 1447292248

  Internal Medicine

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Med Care Plus Home Health, Inc.

  • Home Health Agency
  • Pasadena, CA
  • NPI 1871963140
  Care Compare affiliation

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

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764115200000",
    "number": "1033601844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5379 HAMNER AVE UNIT 801",
            "city": "EASTVALE",
            "state": "CA",
            "postal_code": "917521042",
            "telephone_number": "888-854-1397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5379 HAMNER AVE UNIT 801",
            "city": "EASTVALE",
            "state": "CA",
            "postal_code": "917521042",
            "telephone_number": "888-854-1397"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 N Waterman Ave",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924045115",
            "country_code": "US",
            "telephone_number": "909-883-8611 x22278",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KASANAGOTTU",
        "first_name": "KOUSHIK",
        "middle_name": "PRUDVI",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-06",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "186556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaiser Permanente
• Kaitlin Chin
• Daniel Njoroge Kaiyare
• Florence N Kamau
• Christine W Karuchi, RN
• Kate Pharmaceutical Corp (Arise Pharmacy)
• Kate Pharmaceutical Corp (Arise Pharmacy)
• Kate Pharmaceutical Corp
• Lovelin Kaur
• Beverley Kellman

• Internal Medicine Physician in Eastvale, CA
• Providers in Eastvale, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.