Marc J Lanuza, PA
Physician Assistant · Los Gatos
- Medicare standing
- Clear
- Enrolled, allowed to bill and order, not excluded
- Plans that list them
- Not verified
- Not the same as out of network.
- Office
- 1
Offices
1 location · El Camino Health Medical Network LLC · 202 clinicians in this group
Looking this up.
Hospitals listed: El Camino Health · Santa Clara Valley Medical Center. That is not proof they admit you there this week.
Plan participation
Not verified
We could not verify current plan participation for this doctor. This does not mean they are out of network. Call Marc J Lanuza’s office at (408) 866-4070 to ask if they take your plan before you enroll.
Hospitals they work in
2 hospitals
These rate the hospital, not this clinician. Most measures at most hospitals are no different from the national rate.
- El Camino HealthMountain View, CAAcute Care Hospital · Government - Hospital District or Authority · Has an emergency department · Birthing-friendlyPart of El Camino Health, which runs 2 hospitalsPatients rate it 4 of 5 · 80% would definitely recommend itOverall rating: 4 of 5 starsBetter than the national rate — Central Line Associated Bloodstream Infection (ICU + select Wards): 0.291, Oct 2024 – Sep 2025Better than the national rate — Clostridium Difficile (C.Diff): 0.393, Oct 2024 – Sep 2025Better than the national rate — MRSA Bacteremia: 0, Oct 2024 – Sep 2025
- Santa Clara Valley Medical CenterSan Jose, CAAcute Care Hospital · Government - Local · Has an emergency department · Birthing-friendlyPart of Santa Clara Valley Health and Hospital System, which runs 3 hospitalsPatients rate it 3 of 5 · 70% would definitely recommend itOverall rating: 2 of 5 starsWorse than the national rate — SSI - Colon Surgery: 2.572, Oct 2024 – Sep 2025Better than the national rate — Central Line Associated Bloodstream Infection (ICU + select Wards): 0.563, Oct 2024 – Sep 2025Better than the national rate — Clostridium Difficile (C.Diff): 0.256, Oct 2024 – Sep 2025Better than the national rate — MRSA Bacteremia: 0.369, Oct 2024 – Sep 2025
See every measure and the patient survey for El Camino Health
Behind the star rating — Deaths: 3 better, 5 the same, 0 worse of 8 measures. Safety: 3 better, 5 the same, 0 worse of 8 measures. Readmissions: 1 better, 9 the same, 1 worse of 11 measures. The star rating is worked out from an earlier period than the measures below, so the two can disagree.
| Central Line Associated Bloodstream Infection (ICU + select Wards)Infections | 0.291 | Better | Oct 2024 – Sep 2025 |
| Clostridium Difficile (C.Diff)Infections | 0.393 | Better | Oct 2024 – Sep 2025 |
| MRSA BacteremiaInfections | 0 | Better | Oct 2024 – Sep 2025 |
| Abdominopelvic accidental puncture or laceration rateComplications and deaths | 0.96 (0.12 to 1.79) · 2,340 cases | No different | Jul 2022 – Jun 2024 |
| CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths | 1.02 (0.76 to 1.28) | No different | Jul 2022 – Jun 2024 |
| Death rate among surgical inpatients with serious treatable complicationsComplications and deaths | 167.38 (125.03 to 209.73) · 96 cases | No different | Jul 2022 – Jun 2024 |
| Death rate for CABG surgery patientsComplications and deaths | 2.6 · 68 cases | None | Jul 2022 – Jun 2025 |
| Death rate for COPD patientsComplications and deaths | 7.1 · 185 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart attack patientsComplications and deaths | 11.8 · 200 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart failure patientsComplications and deaths | 8.9 · 814 cases | None | Jul 2022 – Jun 2025 |
| Death rate for pneumonia patientsComplications and deaths | 13 · 842 cases | None | Jul 2022 – Jun 2025 |
| Death rate for stroke patientsComplications and deaths | 9.6 · 361 cases | None | Jul 2023 – Jun 2025 |
| Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths | 2.6 · 4,633 cases | None | Jul 2024 – Jun 2025 |
| Iatrogenic pneumothorax rateComplications and deaths | 0.16 (0 to 0.34) · 11,474 cases | No different | Jul 2022 – Jun 2024 |
| In-hospital fall-associated fracture rateComplications and deaths | 0.27 (0.1 to 0.45) · 11,626 cases | No different | Jul 2022 – Jun 2024 |
| Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths | 3.14 (1.39 to 4.9) · 2,814 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative acute kidney injury requiring dialysis rateComplications and deaths | 2 (0.61 to 3.39) · 1,327 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative hemorrhage or hematoma rateComplications and deaths | 2.11 (0.8 to 3.43) · 2,641 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative respiratory failure rateComplications and deaths | 9.39 (4.18 to 14.6) · 1,287 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative sepsis rateComplications and deaths | 6.57 (3.47 to 9.68) · 1,308 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative wound dehiscence rateComplications and deaths | 2.14 (0.71 to 3.57) · 827 cases | No different | Jul 2022 – Jun 2024 |
| Pressure ulcer rateComplications and deaths | 0.6 (0.05 to 1.15) · 9,460 cases | No different | Jul 2022 – Jun 2024 |
| Rate of complications for hip/knee replacement patientsComplications and deaths | 4.5 · 122 cases | None | Apr 2023 – Mar 2025 |
| Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections | 0.993 | No different | Oct 2024 – Sep 2025 |
| SSI - Abdominal HysterectomyInfections | 0.706 | No different | Oct 2024 – Sep 2025 |
| SSI - Colon SurgeryInfections | 1.376 | No different | Oct 2024 – Sep 2025 |
| Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits | 15.5 · 218 cases | None | Jul 2023 – Jun 2025 |
| Heart failure (HF) 30-Day Readmission RateUnplanned return visits | 19.5 · 962 cases | None | Jul 2023 – Jun 2025 |
| Hospital return days for heart attack patientsUnplanned return visits | 3.8 · 200 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for heart failure patientsUnplanned return visits | -17 · 922 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for pneumonia patientsUnplanned return visits | 18.6 · 860 cases | None | Jul 2022 – Jun 2025 |
| Pneumonia (PN) 30-Day Readmission RateUnplanned return visits | 18.7 · 827 cases | None | Jul 2023 – Jun 2025 |
| Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits | 6.1 (4.5 to 8.2) · 313 cases | No different | Jan 2024 – Dec 2024 |
| Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits | 13.4 (10.6 to 16.5) · 313 cases | No different | Jan 2024 – Dec 2024 |
| Rate of readmission after hip/knee replacementUnplanned return visits | 6.1 · 144 cases | None | Jul 2023 – Jun 2025 |
| Rate of readmission for CABGUnplanned return visits | 10.3 · 80 cases | None | Jul 2023 – Jun 2025 |
| Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits | 20.7 · 237 cases | None | Jul 2023 – Jun 2025 |
| Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits | 12.8 (10 to 16.1) · 1,639 cases | No different | Jan 2022 – Dec 2024 |
| Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits | 0.9 (0.8 to 1.1) · 1,619 cases | No different | Jan 2024 – Dec 2024 |
What patients said (1,535 patients answered, 22% of those asked)
| Cleanliness | 4 |
| Nurse communication | 4 |
| Doctor communication | 4 |
| Communication about medicines | 3 |
| Discharge information | 3 |
| Overall hospital rating | 4 |
| Quietness | 2 |
| Recommend hospital | 5 |
| Room was "always" clean | 75% |
| Nurses "always" communicated well | 79% |
| Doctors "always" communicated well | 81% |
| Staff "always" explained | 61% |
| Yes, staff "did" give patients this information | 86% |
| Yes, staff "did" give patients information about help after discharge | 86% |
| Doctors "always" explained things so they could understand | 76% |
| Doctors "always" listened carefully | 80% |
| Doctors "always" treated them with courtesy and respect | 87% |
| Patients who gave a rating of "9" or "10" (high) | 76% |
| Staff "always" explained new medications | 76% |
| Nurses "always" explained things so they could understand | 75% |
| Nurses "always" listened carefully | 76% |
| Nurses "always" treated them with courtesy and respect | 87% |
| "Always" quiet at night | 47% |
| "YES", patients would definitely recommend the hospital | 80% |
| Staff "always" explained possible side effects | 46% |
| Yes, staff "did" give patients information about possible symptoms | 86% |
See every measure and the patient survey for Santa Clara Valley Medical Center
Behind the star rating — Deaths: 2 better, 6 the same, 0 worse of 8 measures. Safety: 2 better, 5 the same, 1 worse of 8 measures. Readmissions: 0 better, 10 the same, 1 worse of 11 measures. The star rating is worked out from an earlier period than the measures below, so the two can disagree.
| SSI - Colon SurgeryInfections | 2.572 | Worse | Oct 2024 – Sep 2025 |
| Central Line Associated Bloodstream Infection (ICU + select Wards)Infections | 0.563 | Better | Oct 2024 – Sep 2025 |
| Clostridium Difficile (C.Diff)Infections | 0.256 | Better | Oct 2024 – Sep 2025 |
| MRSA BacteremiaInfections | 0.369 | Better | Oct 2024 – Sep 2025 |
| Abdominopelvic accidental puncture or laceration rateComplications and deaths | 1.25 (0.3 to 2.2) · 1,535 cases | No different | Jul 2022 – Jun 2024 |
| CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths | 1.07 (0.76 to 1.38) | No different | Jul 2022 – Jun 2024 |
| Death rate among surgical inpatients with serious treatable complicationsComplications and deaths | 214.59 (167.38 to 261.8) · 108 cases | No different | Jul 2022 – Jun 2024 |
| Death rate for CABG surgery patientsComplications and deaths | 2.8 · 41 cases | None | Jul 2022 – Jun 2025 |
| Death rate for COPD patientsComplications and deaths | 6 · 141 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart attack patientsComplications and deaths | 10.2 · 124 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart failure patientsComplications and deaths | 8.3 · 501 cases | None | Jul 2022 – Jun 2025 |
| Death rate for pneumonia patientsComplications and deaths | 14.9 · 653 cases | None | Jul 2022 – Jun 2025 |
| Death rate for stroke patientsComplications and deaths | 10.1 · 348 cases | None | Jul 2023 – Jun 2025 |
| Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths | 3 · 4,502 cases | None | Jul 2024 – Jun 2025 |
| Iatrogenic pneumothorax rateComplications and deaths | 0.24 (0.04 to 0.43) · 9,014 cases | No different | Jul 2022 – Jun 2024 |
| In-hospital fall-associated fracture rateComplications and deaths | 0.34 (0.15 to 0.52) · 9,216 cases | No different | Jul 2022 – Jun 2024 |
| Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths | 4.54 (2.51 to 6.58) · 1,421 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative acute kidney injury requiring dialysis rateComplications and deaths | 1.54 (0 to 3.2) · 288 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative hemorrhage or hematoma rateComplications and deaths | 2.11 (0.66 to 3.56) · 1,446 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative respiratory failure rateComplications and deaths | 11.61 (4.09 to 19.14) · 294 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative sepsis rateComplications and deaths | 7.29 (3.39 to 11.2) · 299 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative wound dehiscence rateComplications and deaths | 1.9 (0.45 to 3.36) · 333 cases | No different | Jul 2022 – Jun 2024 |
| Pressure ulcer rateComplications and deaths | 0.23 (0 to 0.78) · 7,538 cases | No different | Jul 2022 – Jun 2024 |
| Rate of complications for hip/knee replacement patientsComplications and deaths | 5.4 · 94 cases | None | Apr 2023 – Mar 2025 |
| Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections | 0.735 | No different | Oct 2024 – Sep 2025 |
| SSI - Abdominal HysterectomyInfections | 2.573 | No different | Oct 2024 – Sep 2025 |
| Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits | 14.6 · 185 cases | None | Jul 2023 – Jun 2025 |
| Heart failure (HF) 30-Day Readmission RateUnplanned return visits | 22.1 · 951 cases | None | Jul 2023 – Jun 2025 |
| Hospital return days for heart attack patientsUnplanned return visits | 56.3 · 128 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for heart failure patientsUnplanned return visits | 6.4 · 644 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for pneumonia patientsUnplanned return visits | 1.3 · 699 cases | None | Jul 2022 – Jun 2025 |
| Pneumonia (PN) 30-Day Readmission RateUnplanned return visits | 16.3 · 921 cases | None | Jul 2023 – Jun 2025 |
| Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits | 5.7 (3.9 to 8.1) · 226 cases | No different | Jan 2024 – Dec 2024 |
| Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits | 12.6 (9.4 to 16.5) · 226 cases | No different | Jan 2024 – Dec 2024 |
| Rate of readmission after hip/knee replacementUnplanned return visits | 5.4 · 94 cases | None | Jul 2023 – Jun 2025 |
| Rate of readmission for CABGUnplanned return visits | 11.4 · 54 cases | None | Jul 2023 – Jun 2025 |
| Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits | 20.3 · 242 cases | None | Jul 2023 – Jun 2025 |
| Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits | 13.2 (9.9 to 17.4) · 702 cases | No different | Jan 2022 – Dec 2024 |
| Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits | 1 (0.7 to 1.4) · 195 cases | No different | Jan 2024 – Dec 2024 |
What patients said (4,032 patients answered, 29% of those asked)
| Cleanliness | 3 |
| Nurse communication | 3 |
| Doctor communication | 3 |
| Communication about medicines | 3 |
| Discharge information | 2 |
| Overall hospital rating | 3 |
| Quietness | 2 |
| Recommend hospital | 4 |
| Room was "always" clean | 70% |
| Nurses "always" communicated well | 73% |
| Doctors "always" communicated well | 76% |
| Staff "always" explained | 57% |
| Yes, staff "did" give patients this information | 82% |
| Yes, staff "did" give patients information about help after discharge | 82% |
| Doctors "always" explained things so they could understand | 71% |
| Doctors "always" listened carefully | 74% |
| Doctors "always" treated them with courtesy and respect | 82% |
| Patients who gave a rating of "9" or "10" (high) | 67% |
| Staff "always" explained new medications | 71% |
| Nurses "always" explained things so they could understand | 71% |
| Nurses "always" listened carefully | 69% |
| Nurses "always" treated them with courtesy and respect | 80% |
| "Always" quiet at night | 43% |
| "YES", patients would definitely recommend the hospital | 70% |
| Staff "always" explained possible side effects | 44% |
| Yes, staff "did" give patients information about possible symptoms | 83% |
Original Medicare doctor bills
$45,827
Medicare paid this office $45,827 for 296 people.
This is what Medicare paid the clinician — not Medicare Advantage, and not the pharmacy.
| Short return visit (20+ min) | 197 | $18,815 | $65 |
| Return visit (30+ min) | 124 | $12,201 | $87 |
| Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 51 | $6,988 | $137 |
| New patient visit (45+ min) | 22 | $2,069 | $94 |
| Influenza vaccine split virus, preservative free | 19 | $1,627 | $81 |
See all 10 services
| Short return visit (20+ min) | 197 | $18,815 | $65 |
| Return visit (30+ min) | 124 | $12,201 | $87 |
| Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 51 | $6,988 | $137 |
| New patient visit (45+ min) | 22 | $2,069 | $94 |
| Influenza vaccine split virus, preservative free | 19 | $1,627 | $81 |
| Administration of influenza virus vaccine | 21 | $860 | $39 |
| Injection of drug or substance under skin or into muscle | 18 | $424 | $9 |
| Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's | 11 | $122 | $11 |
| Urinalysis, manual test | 24 | $106 | $3 |
| Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg | 25 | $55 | None |
Who their Medicare patients are
296 Original Medicare patients in 2024. Average age 75 · Under 65 4% · 85 and older 14% · Women 59% · Also on Medicaid 7% · Health risk score 0.98. At or below the middle of the specialty; the typical physician assistant clinician is at 1.31.
Conditions among them: High blood pressure 75% · Diabetes 30% · Coronary heart disease 24% · Chronic kidney disease 19% · Depression 16% · Atrial fibrillation 14% · Cancer 11% · Heart failure 10% · COPD 10% · Stroke 8% · Dementia 6%.
The office billed $222,219, Medicare allowed $63,855 and paid $45,827; for 756 services of 29 kinds; $2,865 of it was for drugs given in the office and $42,962 for care.
Original Medicare patients only. A risk score of 1.0 is the average Medicare patient; higher means sicker. Any count under 11 is hidden.
Year by year
| 2024 | 296 | 756 | 75 | 0.98 | $222,219 | $45,827 |
| 2023 | 310 | 706 | 75 | 0.92 | $219,483 | $46,383 |
| 2022 | 220 | 413 | 75 | 0.89 | $126,791 | $30,072 |
| 2020 | 18 | 24 | 73 | 0.83 | $5,338 | $464 |
| 2019 | 55 | 67 | 73 | 1.00 | $14,684 | $3,274 |
| 2018 | 111 | 450 | 70 | 0.97 | $70,561 | $23,230 |
| 2017 | 136 | 596 | 71 | 1.10 | $89,347 | $30,695 |
| 2016 | 90 | 390 | 70 | 0.83 | $54,041 | $17,376 |
| 2015 | 114 | 488 | 70 | 1.10 | $60,271 | $23,394 |
| 2014 | 92 | 416 | 72 | 0.90 | $52,682 | $19,166 |
| 2013 | 121 | 373 | 72 | 0.98 | $45,917 | $15,071 |
Original Medicare only. A service billed for fewer than 11 people in a year is hidden, so the lines can add up to less than the year's total.
See the services billed each year
2023: 13 services
| Short return visit (20+ min) | 226 | $20,307 | $61 |
| Return visit (30+ min) | 53 | $5,070 | $92 |
| Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 34 | $4,506 | $133 |
| Transitional care management services for problem of high complexity | 11 | $2,519 | $229 |
| New patient visit (45+ min) | 25 | $2,369 | $95 |
| Influenza vaccine split virus, preservative free | 21 | $1,450 | $69 |
| New patient visit (30+ min) | 20 | $1,423 | $71 |
| Administration of influenza virus vaccine | 26 | $817 | $30 |
| Administration of pneumococcal vaccine | 20 | $628 | $31 |
| Office for the evaluation and management of established patient that may not require presence of healthcare professional | 12 | $246 | $18 |
| Injection of drug or substance under skin or into muscle | 13 | $143 | $9 |
| Urinalysis, manual test | 20 | $79 | $3 |
| Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg | 18 | $46 | None |
2022: 8 services
| Short return visit (20+ min) | 164 | $15,160 | $70 |
| Return visit (30+ min) | 32 | $3,308 | $103 |
| Telephone medical discussion with physician, 21-30 minutes | 21 | $2,330 | $101 |
| New patient visit (45+ min) | 17 | $1,908 | $112 |
| Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 12 | $1,635 | $136 |
| Influenza vaccine split virus, preservative free | 18 | $1,234 | $69 |
| Administration of influenza virus vaccine | 21 | $674 | $32 |
| Urinalysis, manual test | 20 | $76 | $3 |
2019: 2 services
| Return visit (30+ min) | 22 | $1,631 | $74 |
| Short return visit (20+ min) | 31 | $928 | $29 |
2018: 9 services
| Short return visit (20+ min) | 97 | $8,729 | $43 |
| Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 36 | $4,232 | $118 |
| Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 16 | $2,735 | $171 |
| Return visit (30+ min) | 26 | $2,297 | $77 |
| Influenza vaccine split virus, preservative free | 21 | $1,098 | $52 |
| Administration of influenza virus vaccine | 28 | $733 | $25 |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report | 11 | $110 | $10 |
| Stool analysis for blood to screen for colon tumors | 24 | $103 | $4 |
| Urinalysis, manual test | 11 | $44 | $3 |
2017: 11 services
| Short return visit (20+ min) | 117 | $11,651 | $43 |
| Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 49 | $5,593 | $114 |
| Pneumococcal vaccine, 13-valent | 17 | $3,198 | $188 |
| Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 16 | $2,671 | $167 |
| Influenza vaccine, inactivated | 32 | $1,562 | $49 |
| Administration of influenza virus vaccine | 42 | $1,306 | $31 |
| Return visit (30+ min) | 15 | $919 | $57 |
| Administration of pneumococcal vaccine | 23 | $746 | $31 |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report | 15 | $200 | $12 |
| Stool analysis for blood to screen for colon tumors | 26 | $114 | $4 |
| Urinalysis, manual test | 14 | $48 | $3 |
2016: 9 services
| Short return visit (20+ min) | 76 | $6,264 | $37 |
| Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 31 | $3,390 | $109 |
| Return visit (30+ min) | 19 | $1,307 | $62 |
| Influenza vaccine, inactivated | 23 | $842 | $37 |
| Administration of influenza virus vaccine | 25 | $778 | $30 |
| Administration of pneumococcal vaccine | 11 | $329 | $30 |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report | 20 | $221 | $11 |
| Stool analysis for blood to screen for colon tumors | 20 | $87 | $4 |
| Urinalysis, manual test | 15 | $61 | $3 |
2015: 10 services
| Short return visit (20+ min) | 89 | $9,335 | $43 |
| Return visit (30+ min) | 39 | $2,929 | $60 |
| Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 24 | $2,691 | $112 |
| Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 16 | $2,627 | $164 |
| Administration of influenza virus vaccine | 47 | $1,411 | $30 |
| Influenza vaccine split virus, preservative free | 24 | $887 | $35 |
| Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin) | 25 | $387 | $15 |
| Administration of pneumococcal vaccine | 12 | $360 | $30 |
| Stool analysis for blood to screen for colon tumors | 20 | $87 | $4 |
| Urinalysis, manual test | 20 | $72 | $3 |
2014: 9 services
| Short return visit (20+ min) | 69 | $8,494 | $43 |
| Return visit (30+ min) | 43 | $3,578 | $63 |
| Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 15 | $2,420 | $161 |
| Influenza vaccine split virus, preservative free | 31 | $1,011 | $33 |
| Pneumococcal vaccine, 23-valent | 12 | $899 | $75 |
| Administration of influenza virus vaccine | 27 | $794 | $29 |
| Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin) | 13 | $194 | $15 |
| Urinalysis, manual test | 25 | $96 | $3 |
| Stool analysis for blood to screen for colon tumors | 12 | $52 | $4 |
2013: 6 services
| Short return visit (20+ min) | 98 | $9,019 | $46 |
| Return visit (30+ min) | 51 | $3,011 | $58 |
| Influenza vaccine split virus, preservative free | 17 | $470 | $28 |
| Administration of influenza virus vaccine | 15 | $441 | $29 |
| Administration of vaccine | 12 | $204 | $16 |
| Urinalysis, manual test | 24 | $83 | $3 |
Drugs they prescribed that Part D paid
$99,937
Pharmacies billed $99,937 in 2024.
This is pharmacy cost, not the office bill, and not what patients paid.
Opioids were 1% of their Part D prescriptions (14 of 2,171) in 2024. At or below the middle of the specialty; the typical physician assistant clinician is at 1%.
1,947 generic and 206 brand-name prescriptions · $99,937 in drug cost · 219 antibiotic prescriptions to 159 people.
Part D prescriptions only. The opioid rate is opioid prescriptions as a share of all this clinician's Part D prescriptions; surgeons and pain specialists run higher than others, so it is shown against the same specialty.
| Ozempic | 16 | $18,628 | $1,164 |
| Paxlovid | 31 | $4,158 | $134 |
| Atorvastatin | 165 | $1,615 | $10 |
| Clotrimazole-Betamethasone | 49 | $1,216 | $25 |
| Neomycin-Polymyxin-Hydrocort | 25 | $1,192 | $48 |
See all 47 drugs
| Ozempic | 16 | $18,628 | $1,164 |
| Paxlovid | 31 | $4,158 | $134 |
| Atorvastatin | 165 | $1,615 | $10 |
| Clotrimazole-Betamethasone | 49 | $1,216 | $25 |
| Neomycin-Polymyxin-Hydrocort | 25 | $1,192 | $48 |
| Levothyroxine | 114 | $1,035 | $9 |
| Albuterol Sulfate Hfa | 23 | $743 | $32 |
| Amlodipine Besylate | 97 | $649 | $7 |
| Gabapentin | 45 | $642 | $14 |
| Fluoxetine | 16 | $639 | $40 |
| Tolterodine Tartrate Er | 14 | $625 | $45 |
| Tamsulosin | 37 | $514 | $14 |
| Lisinopril | 81 | $510 | $6 |
| Losartan | 82 | $497 | $6 |
| Rosuvastatin | 45 | $471 | $10 |
| Metoprolol | 43 | $467 | $11 |
| Potassium Chloride | 21 | $397 | $19 |
| Metformin | 51 | $391 | $8 |
| Escitalopram | 14 | $383 | $27 |
| Doxycycline Hyclate | 34 | $365 | $11 |
| Amoxicillin-Clavulanate Potass | 45 | $339 | $8 |
| Ibuprofen | 62 | $309 | $5 |
| Pantoprazole | 31 | $270 | $9 |
| Famotidine | 19 | $219 | $12 |
| Furosemide | 24 | $199 | $8 |
| Omeprazole | 39 | $180 | $5 |
| Cephalexin | 29 | $171 | $6 |
| Amlodipine Besylate-Benazepril | 12 | $168 | $14 |
| Carvedilol | 16 | $167 | $10 |
| Allopurinol | 17 | $159 | $9 |
| Duloxetine | 18 | $154 | $9 |
| Vitamin D2 | 11 | $149 | $14 |
| Clindamycin | 15 | $141 | $9 |
| Atenolol | 12 | $141 | $12 |
| Paroxetine | 16 | $131 | $8 |
| Metoprolol | 32 | $125 | $4 |
| Azithromycin | 33 | $124 | $4 |
| Cyclobenzaprine | 14 | $115 | $8 |
| Ciprofloxacin | 28 | $115 | $4 |
| Simvastatin | 15 | $113 | $8 |
| Hydrochlorothiazide | 31 | $109 | $4 |
| Nitrofurantoin Mono-Macro | 12 | $106 | $9 |
| Metformin Hcl Er | 22 | $101 | $5 |
| Alendronate | 23 | $94 | $4 |
| Trazodone | 13 | $94 | $7 |
| Sertraline | 11 | $72 | $7 |
| Alprazolam | 12 | $27 | $2 |
Year by year
| 2024 | 2,171 | 500 | 1% (14) | 9% | $99,937 |
| 2023 | 1,706 | 505 | 1% (14) | 7% | $77,219 |
| 2022 | 1,722 | 568 | 1% (24) | 10% | $128,500 |
| 2021 | 345 | 132 | 0% (0) | None | $53,708 |
| 2020 | 64 | 36 | None | None | $2,307 |
| 2019 | 335 | 96 | None | 16% | $25,512 |
| 2018 | 1,231 | 116 | 1% (17) | None | $90,191 |
| 2017 | 1,363 | 133 | 2% (23) | None | $85,974 |
| 2016 | 1,201 | 99 | None | 17% | $56,258 |
| 2015 | 1,419 | 119 | 1% (19) | None | $74,854 |
| 2014 | 1,793 | 119 | 1% (16) | 23% | $79,841 |
| 2013 | 1,421 | 156 | 2% (22) | 23% | $71,908 |
Part D prescriptions only. A drug prescribed to fewer than 11 people in a year is hidden.
See the drugs prescribed each year
2023: 39 drugs
| Clotrimazole-Betamethasone | 28 | $1,371 | $49 |
| Atorvastatin | 101 | $1,346 | $13 |
| Doxycycline Hyclate | 62 | $1,300 | $21 |
| Levothyroxine | 72 | $1,194 | $17 |
| Neomycin-Polymyxin-Hydrocort | 16 | $1,153 | $72 |
| Albuterol Sulfate Hfa | 35 | $1,023 | $29 |
| Losartan | 68 | $961 | $14 |
| Escitalopram | 24 | $678 | $28 |
| Gabapentin | 31 | $591 | $19 |
| Metformin | 50 | $585 | $12 |
| Lisinopril | 71 | $581 | $8 |
| Tamsulosin | 30 | $577 | $19 |
| Metoprolol | 36 | $544 | $15 |
| Amlodipine Besylate | 77 | $534 | $7 |
| Amoxicillin-Clavulanate Potass | 47 | $504 | $11 |
| Diclofenac | 19 | $423 | $22 |
| Omeprazole | 42 | $405 | $10 |
| Cephalexin | 32 | $395 | $12 |
| Alendronate | 24 | $329 | $14 |
| Paxlovid (Eua) | 30 | $308 | $10 |
| Trazodone | 30 | $286 | $10 |
| Montelukast | 12 | $285 | $24 |
| Rosuvastatin | 27 | $259 | $10 |
| Celecoxib | 12 | $258 | $21 |
| Pravastatin | 11 | $256 | $23 |
| Ibuprofen | 38 | $240 | $6 |
| Pantoprazole | 19 | $229 | $12 |
| Nitrofurantoin Mono-Macro | 13 | $229 | $18 |
| Potassium Chloride | 14 | $194 | $14 |
| Ciprofloxacin | 20 | $182 | $9 |
| Atenolol | 13 | $165 | $13 |
| Simvastatin | 21 | $149 | $7 |
| Carvedilol | 13 | $121 | $9 |
| Cyclobenzaprine | 23 | $117 | $5 |
| Azithromycin | 18 | $102 | $6 |
| Metoprolol | 12 | $94 | $8 |
| Hydrochlorothiazide | 14 | $82 | $6 |
| Furosemide | 15 | $79 | $5 |
| Lorazepam | 12 | $28 | $2 |
2022: 39 drugs
| Lantus Solostar | 14 | $8,366 | $598 |
| Levothyroxine | 73 | $1,544 | $21 |
| Albuterol Sulfate Hfa | 27 | $1,323 | $49 |
| Atorvastatin | 116 | $1,305 | $11 |
| Ezetimibe | 14 | $1,140 | $81 |
| Doxycycline Hyclate | 54 | $1,076 | $20 |
| Tamsulosin | 32 | $963 | $30 |
| Pantoprazole | 18 | $689 | $38 |
| Metformin | 60 | $648 | $11 |
| Gabapentin | 35 | $640 | $18 |
| Ultra-Fine Short Pen Needle | 11 | $587 | $53 |
| Metoprolol | 24 | $584 | $24 |
| Celecoxib | 13 | $572 | $44 |
| Losartan | 55 | $552 | $10 |
| Rosuvastatin | 31 | $537 | $17 |
| Pravastatin | 22 | $521 | $24 |
| Lisinopril | 46 | $452 | $10 |
| Amlodipine Besylate | 67 | $447 | $7 |
| Montelukast | 17 | $440 | $26 |
| Losartan-Hydrochlorothiazide | 15 | $411 | $27 |
| Omeprazole | 22 | $382 | $17 |
| Amoxicillin-Clavulanate Potass | 35 | $381 | $11 |
| Alendronate | 17 | $370 | $22 |
| Potassium Chloride | 11 | $330 | $30 |
| Ibuprofen | 27 | $315 | $12 |
| Simvastatin | 25 | $299 | $12 |
| Allopurinol | 24 | $281 | $12 |
| Carvedilol | 13 | $212 | $16 |
| Azithromycin | 23 | $185 | $8 |
| Cephalexin | 19 | $167 | $9 |
| Paxlovid (Eua) | 13 | $135 | $10 |
| Atenolol | 19 | $128 | $7 |
| Ciprofloxacin | 19 | $124 | $7 |
| Trazodone | 11 | $115 | $10 |
| Glipizide | 11 | $92 | $8 |
| Furosemide | 12 | $85 | $7 |
| Metoprolol | 13 | $78 | $6 |
| Tramadol | 11 | $57 | $5 |
| Hydrochlorothiazide | 11 | $45 | $4 |
2021: 6 drugs
| Atorvastatin | 26 | $441 | $17 |
| Levothyroxine | 15 | $421 | $28 |
| Losartan | 18 | $381 | $21 |
| Metformin | 18 | $283 | $16 |
| Amlodipine Besylate | 16 | $214 | $13 |
| Lisinopril | 18 | $201 | $11 |
2019: 6 drugs
| Atorvastatin | 21 | $403 | $19 |
| Allopurinol | 20 | $358 | $18 |
| Losartan | 23 | $259 | $11 |
| Omeprazole | 11 | $149 | $14 |
| Simvastatin | 16 | $124 | $8 |
| Amlodipine Besylate | 11 | $47 | $4 |
2018: 31 drugs
| Januvia | 22 | $14,356 | $653 |
| Farxiga | 13 | $7,816 | $601 |
| Tradjenta | 12 | $6,936 | $578 |
| Advair Hfa | 12 | $4,069 | $339 |
| Atorvastatin | 83 | $1,491 | $18 |
| Gabapentin | 46 | $1,314 | $29 |
| Ventolin Hfa | 18 | $1,013 | $56 |
| Allopurinol | 57 | $993 | $17 |
| Losartan | 83 | $914 | $11 |
| Levothyroxine | 33 | $773 | $23 |
| Metformin | 62 | $635 | $10 |
| Montelukast | 25 | $423 | $17 |
| Metoprolol | 14 | $378 | $27 |
| Omeprazole | 36 | $371 | $10 |
| Simvastatin | 55 | $338 | $6 |
| Losartan-Hydrochlorothiazide | 29 | $267 | $9 |
| Pioglitazone | 18 | $259 | $14 |
| Fluticasone Propionate | 21 | $247 | $12 |
| Lisinopril | 36 | $239 | $7 |
| Pantoprazole | 26 | $219 | $8 |
| Amlodipine Besylate | 41 | $203 | $5 |
| Alendronate | 26 | $188 | $7 |
| Glimepiride | 12 | $178 | $15 |
| Amoxicillin-Clavulanate Potass | 13 | $162 | $12 |
| Atenolol | 19 | $149 | $8 |
| Hydrochlorothiazide | 30 | $146 | $5 |
| Metoprolol | 17 | $137 | $8 |
| Tramadol | 11 | $83 | $8 |
| Ibuprofen | 12 | $57 | $5 |
| Citalopram Hbr | 16 | $56 | $3 |
| Furosemide | 11 | $30 | $3 |
2017: 31 drugs
| Januvia | 17 | $12,755 | $750 |
| Tradjenta | 14 | $7,638 | $546 |
| Atorvastatin | 88 | $1,459 | $17 |
| Allopurinol | 57 | $1,216 | $21 |
| Ventolin Hfa | 18 | $960 | $53 |
| Levothyroxine | 32 | $931 | $29 |
| Gabapentin | 35 | $752 | $21 |
| Metformin | 79 | $710 | $9 |
| Proair Hfa | 12 | $682 | $57 |
| Losartan | 62 | $598 | $10 |
| Metoprolol | 23 | $583 | $25 |
| Valsartan-Hydrochlorothiazide | 16 | $535 | $33 |
| Simvastatin | 74 | $466 | $6 |
| Valsartan | 17 | $423 | $25 |
| Montelukast | 18 | $421 | $23 |
| Glimepiride | 20 | $367 | $18 |
| Omeprazole | 41 | $356 | $9 |
| Pioglitazone | 32 | $339 | $11 |
| Lisinopril | 45 | $320 | $7 |
| Amlodipine Besylate | 50 | $272 | $5 |
| Amoxicillin-Clavulanate Potass | 21 | $272 | $13 |
| Losartan-Hydrochlorothiazide | 24 | $255 | $11 |
| Pantoprazole | 30 | $253 | $8 |
| Fluticasone Propionate | 24 | $236 | $10 |
| Hydrocodone-Acetaminophen | 11 | $187 | $17 |
| Lovastatin | 14 | $170 | $12 |
| Hydrochlorothiazide | 35 | $150 | $4 |
| Atenolol | 17 | $127 | $7 |
| Lisinopril-Hydrochlorothiazide | 12 | $93 | $8 |
| Alendronate | 17 | $83 | $5 |
| Benazepril | 11 | $67 | $6 |
2016: 30 drugs
| Januvia | 21 | $10,736 | $511 |
| Qvar | 14 | $2,795 | $200 |
| Atorvastatin | 84 | $1,381 | $16 |
| Allopurinol | 57 | $871 | $15 |
| Levothyroxine | 31 | $773 | $25 |
| Fenofibrate | 22 | $633 | $29 |
| Metformin | 84 | $582 | $7 |
| Metoprolol | 17 | $516 | $30 |
| Omeprazole | 45 | $459 | $10 |
| Losartan | 72 | $444 | $6 |
| Montelukast | 27 | $416 | $15 |
| Simvastatin | 60 | $388 | $6 |
| Oxybutynin Chloride | 12 | $380 | $32 |
| Pioglitazone | 40 | $313 | $8 |
| Glimepiride | 26 | $289 | $11 |
| Valsartan-Hydrochlorothiazide | 16 | $253 | $16 |
| Pantoprazole | 33 | $251 | $8 |
| Amlodipine Besylate | 47 | $243 | $5 |
| Valsartan | 16 | $207 | $13 |
| Losartan-Hydrochlorothiazide | 22 | $194 | $9 |
| Lisinopril | 26 | $185 | $7 |
| Hydrochlorothiazide | 24 | $179 | $7 |
| Benazepril | 13 | $156 | $12 |
| Fluticasone Propionate | 15 | $109 | $7 |
| Atenolol | 20 | $102 | $5 |
| Ibuprofen | 16 | $82 | $5 |
| Alendronate | 20 | $66 | $3 |
| Azithromycin | 11 | $55 | $5 |
| Ciprofloxacin | 12 | $53 | $4 |
| Metoprolol | 21 | $45 | $2 |
2015: 36 drugs
| Januvia | 27 | $13,287 | $492 |
| Janumet | 15 | $8,972 | $598 |
| Onglyza | 16 | $6,037 | $377 |
| Crestor | 18 | $4,447 | $247 |
| Spiriva Respimat | 11 | $3,503 | $318 |
| Dulera | 12 | $3,348 | $279 |
| Fenofibrate | 16 | $1,698 | $106 |
| Atorvastatin | 100 | $1,630 | $16 |
| Metoprolol | 35 | $1,052 | $30 |
| Proair Hfa | 20 | $1,024 | $51 |
| Levothyroxine | 40 | $929 | $23 |
| Allopurinol | 65 | $831 | $13 |
| Losartan | 106 | $738 | $7 |
| Metformin | 76 | $694 | $9 |
| Simvastatin | 80 | $644 | $8 |
| Omeprazole | 50 | $535 | $11 |
| Pioglitazone | 14 | $497 | $35 |
| Donepezil | 17 | $395 | $23 |
| Glimepiride | 31 | $381 | $12 |
| Lisinopril | 39 | $370 | $9 |
| Amlodipine Besylate | 65 | $362 | $6 |
| Doxazosin Mesylate | 11 | $284 | $26 |
| Montelukast | 20 | $280 | $14 |
| Fluticasone Propionate | 29 | $250 | $9 |
| Hydrochlorothiazide | 38 | $244 | $6 |
| Pantoprazole | 20 | $192 | $10 |
| Alendronate | 32 | $166 | $5 |
| Valsartan-Hydrochlorothiazide | 14 | $161 | $11 |
| Amoxicillin-Clavulanate Potass | 13 | $157 | $12 |
| Metoprolol | 31 | $154 | $5 |
| Ibuprofen | 21 | $133 | $6 |
| Hydrocodone-Acetaminophen | 12 | $105 | $9 |
| Paroxetine | 12 | $91 | $8 |
| Atenolol | 16 | $75 | $5 |
| Ciprofloxacin | 12 | $66 | $5 |
| Terazosin | 12 | $56 | $5 |
2014: 41 drugs
| Januvia | 23 | $9,519 | $414 |
| Janumet | 23 | $8,132 | $354 |
| Onglyza | 15 | $4,892 | $326 |
| Crestor | 18 | $4,209 | $234 |
| Diovan | 15 | $3,107 | $207 |
| Colcrys | 15 | $2,467 | $164 |
| Uloric | 11 | $1,873 | $170 |
| Atorvastatin | 100 | $1,630 | $16 |
| Metformin | 130 | $1,587 | $12 |
| Pioglitazone | 31 | $1,560 | $50 |
| Metoprolol | 32 | $1,189 | $37 |
| Clotrimazole-Betamethasone | 12 | $1,153 | $96 |
| Simvastatin | 110 | $1,097 | $10 |
| Levothyroxine | 58 | $1,040 | $18 |
| Losartan | 96 | $879 | $9 |
| Omeprazole | 62 | $680 | $11 |
| Allopurinol | 71 | $591 | $8 |
| Lisinopril | 82 | $553 | $7 |
| Fluticasone Propionate | 32 | $552 | $17 |
| Amlodipine Besylate | 81 | $548 | $7 |
| Proair Hfa | 11 | $534 | $49 |
| Glimepiride | 45 | $512 | $11 |
| Montelukast | 18 | $468 | $26 |
| Alendronate | 57 | $428 | $8 |
| Hydrochlorothiazide | 60 | $382 | $6 |
| Donepezil | 15 | $369 | $25 |
| Potassium Chloride | 11 | $274 | $25 |
| Pantoprazole | 24 | $240 | $10 |
| Tamsulosin | 11 | $235 | $21 |
| Gemfibrozil | 12 | $233 | $19 |
| Atenolol | 36 | $228 | $6 |
| Metoprolol | 34 | $198 | $6 |
| Lovastatin | 15 | $198 | $13 |
| Losartan-Hydrochlorothiazide | 11 | $180 | $16 |
| Meclizine | 11 | $171 | $16 |
| Gabapentin | 11 | $160 | $15 |
| Hydrocodone-Acetaminophen | 12 | $102 | $9 |
| Zolpidem | 12 | $99 | $8 |
| Azithromycin | 11 | $98 | $9 |
| Carvedilol | 15 | $86 | $6 |
| Ibuprofen | 13 | $86 | $7 |
2013: 33 drugs
| Januvia | 39 | $12,281 | $315 |
| Diovan | 24 | $4,826 | $201 |
| Onglyza | 11 | $2,771 | $252 |
| Pioglitazone | 30 | $1,799 | $60 |
| Metformin | 141 | $1,434 | $10 |
| Atorvastatin | 62 | $1,336 | $22 |
| Losartan | 47 | $832 | $18 |
| Montelukast | 15 | $818 | $55 |
| Simvastatin | 76 | $795 | $10 |
| Clopidogrel | 11 | $659 | $60 |
| Metoprolol | 14 | $655 | $47 |
| Levothyroxine | 52 | $646 | $12 |
| Pantoprazole | 30 | $594 | $20 |
| Fluticasone Propionate | 23 | $519 | $23 |
| Omeprazole | 31 | $488 | $16 |
| Amlodipine Besylate | 39 | $411 | $11 |
| Lisinopril | 47 | $356 | $8 |
| Allopurinol | 58 | $347 | $6 |
| Glimepiride | 32 | $269 | $8 |
| Atenolol | 33 | $252 | $8 |
| Lovastatin | 11 | $229 | $21 |
| Hydrochlorothiazide | 46 | $220 | $5 |
| Losartan-Hydrochlorothiazide | 13 | $198 | $15 |
| Hydrocodone-Acetaminophen | 20 | $188 | $9 |
| Lisinopril-Hydrochlorothiazide | 11 | $181 | $16 |
| Alendronate | 16 | $177 | $11 |
| Paroxetine | 15 | $140 | $9 |
| Metoprolol | 31 | $129 | $4 |
| Ibuprofen | 15 | $102 | $7 |
| Sulfamethoxazole-Trimethoprim | 22 | $97 | $4 |
| Glipizide | 13 | $87 | $7 |
| Amoxicillin | 12 | $75 | $6 |
| Cephalexin | 11 | $73 | $7 |
Money from drug and device companies
$144 in 2023
| 2023 | 2 | 4 | None | $144 |
| 2021 | 4 | 11 | None | $296 |
Paid work is consulting, speaking, honoraria and royalties, as opposed to meals and travel.
A payment is not proof that care is biased.
| GlaxoSmithKline | Arexvy | $96 | 2 payments
|
| Exact Sciences | Cologuard Collection Kit | $48 | 2 payments
|
See all 4 published payments
| Exact Sciences | Meals · 2023-12-06 | Cologuard Collection Kit | $24 |
| GlaxoSmithKline | Meals · 2023-08-23 | Arexvy | $74 |
| GlaxoSmithKline | Meals · 2023-07-10 | Arexvy | $22 |
| Exact Sciences | Meals · 2023-02-21 | Cologuard Collection Kit | $24 |
See earlier years (2021)
2021: $296
| Novo Nordisk | Rybelsus | $143 | 7 payments
|
| Dexcom | Dexcom G6 Transmitter | $102 | 1 payment
|
| Boehringer Ingelheim Pharmaceuticals | Tradjenta | $34 | 2 payments
|
| AstraZeneca Pharmaceuticals LP | None | $16 | 1 payment
|
Checkups this office reported
Medicare did not publish checkup rates for this clinician.
- Medicare’s overall office score
- 83.6 / 100
- Scores the office’s reporting and systems. It is not a grade for how the doctor treats you.
Professional record
- NPI
- 1184840803
- Licence
- CA PA17362
- Video visits
- Lists video visits
- Gender
- Male
More record details
- Sole proprietor
- No
- Taxonomy
- Physician assistant, medical (363AM0700X)
- Mailing address
- 325 Distel Cir, Los Altos, CA, 94022
- NPI first listed
- 2007-04-18
- NPI last updated
- 2019-08-09
This is when the NPI record was last certified, not a medical board exam.