KOUSHIK PRUDVI KASANAGOTTU MD
NPI 1033601844
Internal Medicine in Eastvale, CA

Active since June 06, 2018PECOS EnrolledAccepts Medicare Assignment
5379 HAMNER AVE UNIT 801, EASTVALE, CA 91752(888) 854-1397 Get Directions Write a Review

NPPES record last updated: November 26, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Nov 26, 2025, Nov 20, 2025, Jun 19, 2023 (3 updates tracked since 2023).

About Koushik Prudvi Kasanagottu Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KOUSHIK PRUDVI KASANAGOTTU MD (NPI 1033601844) is an individual internal medicine provider in Eastvale, California, licensed in California (186556) and active in the NPI registry since June 2018. He is enrolled in Medicare PECOS, maintains a secondary practice location in San Bernardino, and is a graduate of Other (2018).

NPPES Registry Identity

NPI1033601844
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameKOUSHIK PRUDVI KASANAGOTTUCredential: MD
Location Address5379 HAMNER AVE UNIT 801Eastvale, CA 91752-1042
Mailing Address5379 Hamner Ave Unit 801Eastvale, CA 91752-1042 · (888) 854-1397
Sole ProprietorYes
Medical School CMSOtherGraduated 2018
Enumeration DateJune 6, 2018
Last NPPES UpdateNovember 26, 20253 updates tracked since enumeration
NPPES CertifiedNovember 26, 2025
NPI 1033601844 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License Licensed in CA · 186556
Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

5379 HAMNER AVE UNIT 801, Eastvale, CA 91752

Secondary Practice Location 1

Location 11700 N Waterman AveSan Bernardino, CA 92404-5115 · Phone (909) 883-8611 ext. 22278

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Koushik Prudvi Kasanagottu Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6709135783
PECOS Enrollment IDI20230804000886
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
136 services74 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
84 services48 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
70 services70 patients
Influenza vaccine, inactivated 90653
The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.
45 services45 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
14 services14 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 91752 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$136.04 typical visit price
range $59.60 – $179.42
Typical copayment $34.01 (range $14.90 – $44.85)
Most-billed visit code 99204
Established Patient
$104.64 typical visit price
range $19.37 – $146.42
Typical copayment $26.16 (range $4.84 – $36.60)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
1 supplier12 claims12 services$71.82 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Clinic/Center (Multi-Specialty)
5379 HAMNER AVE UNIT 801
EASTVALE, CA 91752
Family Medicine
5379 HAMNER AVE UNIT 801
EASTVALE, CA 91752

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1033601844, enumerated as an "individual" on June 06, 2018.

The provider is located at 5379 HAMNER AVE UNIT 801 EASTVALE, CA 91752 and the phone number is (888) 854-1397.

Internal Medicine with taxonomy code 207R00000X.