Yashaswi Koguru, M.D.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

809 82ND Pkwy Grand Stand Medical Center
Myrtle Beach, SC 29572

Phone

(843) 692-1118

Fax

(843) 692-1122

NPI assigned

May 7, 2024

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: yashaswi.koguru@hca5.eclinicaldirectplus.com

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

{
    "created_epoch": "1715040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726790400000",
    "number": "1891543872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 82ND PKWY GRAND STAND MEDICAL CENTER",
            "address_2": "GME OFFICE",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "29572",
            "telephone_number": "843-692-1118",
            "fax_number": "843-692-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 82ND PKWY GRAND STAND MEDICAL CENTER",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "29572",
            "telephone_number": "843-692-1118",
            "fax_number": "843-692-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOGURU",
        "first_name": "YASHASWI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-07",
        "last_updated": "2024-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Knuttel
• Shaemaa Esam Kobarli
• Michele L Kocent
• Alimitha Monali Kodali, MD
• Jeanmarie Koehn, CRT,RCP
• Venkata Sai Kolluru, DO
• Geeth Abhishek Kondaveeti, MD
• John Konopka, OT
• Jimmy L Kontos, MD
• Teresa Regina Kontos, MD

• Student in an Organized Health Care Education/Training Program in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Student in an Organized Health Care Education/Training Program in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.