Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Koushik Prudvi Kasanagottu, MD

Individual provider Internal Medicine Physician · NPI 1033601844

Koushik Prudvi Kasanagottu, MD is an Internal Medicine in Eastvale, California. Qualified in 2018, 8 years ago. Practices with Beaver Medical Group P C, a 255-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in California.

Years since qualifying
8
Licensed in
CA
In the registry since
2018
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

5379 Hamner Ave Unit 801
Eastvale, CA 91752-1042
Phone: (888) 854-1397
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1700 N Waterman Ave, San Bernardino, CA 92404-5115 — (909) 883-8611

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 186556 (CA)

Record details

NPI number1033601844
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJune 6, 2018
Last updated in NPPESNovember 26, 2025
Certification dateNovember 26, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Beaver Medical Group P C — 255 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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