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Nirmal S Aujla, MD

Nephrology · Merced

NPI 1275637506

Medicare standing
Clear
Enrolled, allowed to bill and order, not excluded
Plans that list them
9
1 carrier
Offices
3
Since medical school
46 years
Graduated 1980

Offices

3 locations · Merced Turlock Nephrology Med Group Inc. · 2 clinicians in this group

Looking this up.

Hospitals listed: 552647 · Emanuel Medical Center · Mercy Medical Center. That is not proof they admit you there this week.

Plans that list them

9 plans · 1 carrier

A missing listing does not mean out of network. Directories change, and a listing does not cover every office. Call Dr. Aujla’s office at (209) 723-1020 to confirm they take your plan. Ask about the office you use, its medical group, referrals and appointments.

Plans whose provider directory lists this clinician
Alignment Health BreathEasy (HMO C-SNP)Alignment Health PlanListedOct 3, 2026
Alignment Health Clarity (HMO C-SNP)Alignment Health PlanListedOct 3, 2026
Alignment Health Heart & Diabetes (HMO C-SNP)Alignment Health PlanListedOct 3, 2026
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP)Alignment Health PlanListedOct 3, 2026
Alignment Health Heart & Diabetes Care (HMO C-SNP)Alignment Health PlanListedSep 28, 2026
Alignment Health Heart & Diabetes Choice (HMO C-SNP)Alignment Health PlanListedSep 28, 2026
Alignment Health Honor+ Plan (HMO)Alignment Health PlanListedOct 3, 2026
Alignment Health My Choice CalCare (HMO)Alignment Health PlanListedOct 3, 2026
Alignment Health smartHMO (HMO)Alignment Health PlanListedOct 3, 2026

California Medical Board record

Licence A42706 · Current

Licensed to practise in California · since 1986 · expires 2028-04-30 · Punjab University, Government Medical College.

No disciplinary actions, convictions, malpractice judgments or citations in this record.

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.

  • Emanuel Medical CenterTurlock, CAAcute Care Hospital · Proprietary · Has an emergency department · Birthing-friendlyPart of Tenet Healthcare, which runs 77 hospitals in 12 statesPatients rate it 2 of 5 · 58% would definitely recommend it
    Overall rating: 2 of 5 starsBetter than the national rate — Clostridium Difficile (C.Diff): 0.231, Oct 2024 – Sep 2025
  • Mercy Medical CenterMerced, CAAcute Care Hospital · Voluntary non-profit - Private · Has an emergency department · Birthing-friendlyPart of CommonSpirit Health, which runs 145 hospitals in 19 statesPatients rate it 3 of 5 · 59% would definitely recommend it
    Overall rating: 3 of 5 starsBetter than the national rate — Catheter Associated Urinary Tract Infections (ICU + select Wards): 0, Oct 2024 – Sep 2025Better than the national rate — Central Line Associated Bloodstream Infection (ICU + select Wards): 0.168, Oct 2024 – Sep 2025Better than the national rate — Clostridium Difficile (C.Diff): 0.364, Oct 2024 – Sep 2025
See every measure and the patient survey for Emanuel Medical Center

Behind the star rating — Deaths: 0 better, 7 the same, 0 worse of 7 measures. Safety: 1 better, 5 the same, 0 worse of 6 measures. Readmissions: 0 better, 7 the same, 3 worse of 10 measures. The star rating is worked out from an earlier period than the measures below, so the two can disagree.

Every scored measure at Emanuel Medical Center
Clostridium Difficile (C.Diff)Infections0.231BetterOct 2024 – Sep 2025
Abdominopelvic accidental puncture or laceration rateComplications and deaths0.92 (0 to 1.94) · 622 casesNo differentJul 2022 – Jun 2024
CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths0.86 (0.46 to 1.27)No differentJul 2022 – Jun 2024
Death rate among surgical inpatients with serious treatable complicationsComplications and deaths185.82 (131.99 to 239.65) · 55 casesNo differentJul 2022 – Jun 2024
Death rate for COPD patientsComplications and deaths10.8 · 72 casesNoneJul 2022 – Jun 2025
Death rate for heart attack patientsComplications and deaths11.9 · 287 casesNoneJul 2022 – Jun 2025
Death rate for heart failure patientsComplications and deaths12 · 365 casesNoneJul 2022 – Jun 2025
Death rate for pneumonia patientsComplications and deaths15.9 · 443 casesNoneJul 2022 – Jun 2025
Death rate for stroke patientsComplications and deaths12.3 · 102 casesNoneJul 2023 – Jun 2025
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths4.2 · 1,680 casesNoneJul 2024 – Jun 2025
Iatrogenic pneumothorax rateComplications and deaths0.17 (0 to 0.39) · 4,160 casesNo differentJul 2022 – Jun 2024
In-hospital fall-associated fracture rateComplications and deaths0.24 (0.03 to 0.44) · 4,151 casesNo differentJul 2022 – Jun 2024
Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths3.53 (1.2 to 5.87) · 700 casesNo differentJul 2022 – Jun 2024
Postoperative hemorrhage or hematoma rateComplications and deaths2.84 (1.24 to 4.43) · 734 casesNo differentJul 2022 – Jun 2024
Postoperative wound dehiscence rateComplications and deaths1.7 (0.19 to 3.2) · 146 casesNo differentJul 2022 – Jun 2024
Pressure ulcer rateComplications and deaths0.23 (0 to 1.04) · 3,326 casesNo differentJul 2022 – Jun 2024
Rate of complications for hip/knee replacement patientsComplications and deaths4.2 · 45 casesNoneApr 2023 – Mar 2025
Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections0.908No differentOct 2024 – Sep 2025
MRSA BacteremiaInfections0.836No differentOct 2024 – Sep 2025
SSI - Colon SurgeryInfections0.997No differentOct 2024 – Sep 2025
Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits14.2 · 307 casesNoneJul 2023 – Jun 2025
Heart failure (HF) 30-Day Readmission RateUnplanned return visits21.2 · 461 casesNoneJul 2023 – Jun 2025
Hospital return days for heart attack patientsUnplanned return visits-12.8 · 290 casesNoneJul 2022 – Jun 2025
Hospital return days for heart failure patientsUnplanned return visits-3.8 · 417 casesNoneJul 2022 – Jun 2025
Hospital return days for pneumonia patientsUnplanned return visits37.9 · 472 casesNoneJul 2022 – Jun 2025
Pneumonia (PN) 30-Day Readmission RateUnplanned return visits20.1 · 524 casesNoneJul 2023 – Jun 2025
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits5.5 (3.9 to 7.6) · 264 casesNo differentJan 2024 – Dec 2024
Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits9.7 (7.4 to 12.8) · 264 casesNo differentJan 2024 – Dec 2024
Rate of readmission after hip/knee replacementUnplanned return visits6 · 40 casesNoneJul 2023 – Jun 2025
Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits21.6 · 111 casesNoneJul 2023 – Jun 2025
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits14.2 (10.5 to 19.3) · 257 casesNo differentJan 2022 – Dec 2024
Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits0.9 (0.6 to 1.2) · 289 casesNo differentJan 2024 – Dec 2024

What patients said (704 patients answered, 14% of those asked)

Patient survey stars by topic at Emanuel Medical Center
Cleanliness4
Nurse communication2
Doctor communication2
Communication about medicines2
Discharge information2
Overall hospital rating2
Quietness2
Recommend hospital2
Share of patients giving the best answer at Emanuel Medical Center
Room was "always" clean74%
Nurses "always" communicated well74%
Doctors "always" communicated well73%
Staff "always" explained55%
Yes, staff "did" give patients this information83%
Yes, staff "did" give patients information about help after discharge79%
Doctors "always" explained things so they could understand67%
Doctors "always" listened carefully71%
Doctors "always" treated them with courtesy and respect83%
Patients who gave a rating of "9" or "10" (high)60%
Staff "always" explained new medications70%
Nurses "always" explained things so they could understand68%
Nurses "always" listened carefully71%
Nurses "always" treated them with courtesy and respect83%
"Always" quiet at night39%
"YES", patients would definitely recommend the hospital58%
Staff "always" explained possible side effects40%
Yes, staff "did" give patients information about possible symptoms86%
See every measure and the patient survey for Mercy Medical Center

Behind the star rating — Deaths: 0 better, 5 the same, 1 worse of 6 measures. Safety: 3 better, 3 the same, 0 worse of 6 measures. Readmissions: 0 better, 7 the same, 2 worse of 9 measures. The star rating is worked out from an earlier period than the measures below, so the two can disagree.

Every scored measure at Mercy Medical Center
Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections0BetterOct 2024 – Sep 2025
Central Line Associated Bloodstream Infection (ICU + select Wards)Infections0.168BetterOct 2024 – Sep 2025
Clostridium Difficile (C.Diff)Infections0.364BetterOct 2024 – Sep 2025
Abdominopelvic accidental puncture or laceration rateComplications and deaths1.1 (0.11 to 2.09) · 798 casesNo differentJul 2022 – Jun 2024
CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths0.74 (0.37 to 1.11)No differentJul 2022 – Jun 2024
Death rate for COPD patientsComplications and deaths7.7 · 165 casesNoneJul 2022 – Jun 2025
Death rate for heart attack patientsComplications and deaths11.7 · 69 casesNoneJul 2022 – Jun 2025
Death rate for heart failure patientsComplications and deaths11.3 · 449 casesNoneJul 2022 – Jun 2025
Death rate for pneumonia patientsComplications and deaths17.5 · 544 casesNoneJul 2022 – Jun 2025
Death rate for stroke patientsComplications and deaths11 · 206 casesNoneJul 2023 – Jun 2025
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths3.6 · 1,843 casesNoneJul 2024 – Jun 2025
Iatrogenic pneumothorax rateComplications and deaths0.16 (0 to 0.37) · 5,594 casesNo differentJul 2022 – Jun 2024
In-hospital fall-associated fracture rateComplications and deaths0.23 (0.03 to 0.43) · 5,647 casesNo differentJul 2022 – Jun 2024
Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths2.53 (0.28 to 4.78) · 763 casesNo differentJul 2022 – Jun 2024
Postoperative acute kidney injury requiring dialysis rateComplications and deaths1.64 (0 to 3.35) · 161 casesNo differentJul 2022 – Jun 2024
Postoperative hemorrhage or hematoma rateComplications and deaths1.96 (0.37 to 3.55) · 791 casesNo differentJul 2022 – Jun 2024
Postoperative respiratory failure rateComplications and deaths7.67 (0 to 16.88) · 163 casesNo differentJul 2022 – Jun 2024
Postoperative sepsis rateComplications and deaths4.84 (0.67 to 9.02) · 115 casesNo differentJul 2022 – Jun 2024
Postoperative wound dehiscence rateComplications and deaths1.92 (0.46 to 3.38) · 273 casesNo differentJul 2022 – Jun 2024
Pressure ulcer rateComplications and deaths0.16 (0 to 0.85) · 4,979 casesNo differentJul 2022 – Jun 2024
MRSA BacteremiaInfections0No differentOct 2024 – Sep 2025
SSI - Colon SurgeryInfections0.764No differentOct 2024 – Sep 2025
Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits14 · 31 casesNoneJul 2023 – Jun 2025
Heart failure (HF) 30-Day Readmission RateUnplanned return visits21.5 · 477 casesNoneJul 2023 – Jun 2025
Hospital return days for heart failure patientsUnplanned return visits62.8 · 511 casesNoneJul 2022 – Jun 2025
Hospital return days for pneumonia patientsUnplanned return visits43.6 · 554 casesNoneJul 2022 – Jun 2025
Pneumonia (PN) 30-Day Readmission RateUnplanned return visits18.8 · 462 casesNoneJul 2023 – Jun 2025
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits5.7 (3.8 to 8.2) · 152 casesNo differentJan 2024 – Dec 2024
Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits10.7 (8 to 14.1) · 152 casesNo differentJan 2024 – Dec 2024
Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits19.9 · 196 casesNoneJul 2023 – Jun 2025
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits13.9 (10.2 to 19) · 70 casesNo differentJan 2022 – Dec 2024
Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits1 (0.8 to 1.4) · 413 casesNo differentJan 2024 – Dec 2024

What patients said (394 patients answered, 11% of those asked)

Patient survey stars by topic at Mercy Medical Center
Cleanliness4
Nurse communication3
Doctor communication2
Communication about medicines3
Discharge information3
Overall hospital rating3
Quietness3
Recommend hospital2
Share of patients giving the best answer at Mercy Medical Center
Room was "always" clean73%
Nurses "always" communicated well78%
Doctors "always" communicated well75%
Staff "always" explained61%
Yes, staff "did" give patients this information85%
Yes, staff "did" give patients information about help after discharge83%
Doctors "always" explained things so they could understand73%
Doctors "always" listened carefully72%
Doctors "always" treated them with courtesy and respect80%
Patients who gave a rating of "9" or "10" (high)64%
Staff "always" explained new medications74%
Nurses "always" explained things so they could understand74%
Nurses "always" listened carefully75%
Nurses "always" treated them with courtesy and respect85%
"Always" quiet at night49%
"YES", patients would definitely recommend the hospital59%
Staff "always" explained possible side effects49%
Yes, staff "did" give patients information about possible symptoms86%

Original Medicare doctor bills

$74,148

Medicare paid this office $74,148 for 168 people.

This is what Medicare paid the clinician — not Medicare Advantage, and not the pharmacy.

Largest Original Medicare bills
Dialysis services, 4 or more physician visits per month (20 years or older)20$37,286$254
Return visit (30+ min)62$13,527$82
Dialysis services, 2-3 physician visits per month (20 years or older)12$6,108$211
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes55$4,917$56
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes32$2,949$84
See all 8 services
Every Original Medicare service billed
Dialysis services, 4 or more physician visits per month (20 years or older)20$37,286$254
Return visit (30+ min)62$13,527$82
Dialysis services, 2-3 physician visits per month (20 years or older)12$6,108$211
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes55$4,917$56
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes32$2,949$84
Initial hospital care with moderate level of medical decision making at least 75 minutes20$2,465$123
Short return visit (20+ min)21$1,913$56
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's45$711$12

Who their Medicare patients are

168 Original Medicare patients in 2024. Average age 74 · Under 65 18% · 85 and older 16% · Women 48% · Also on Medicaid 61% · Health risk score 4.22. Above the middle of the specialty; the typical nephrology clinician is at 4.01.

Conditions among them: High blood pressure 75% · Chronic kidney disease 75% · Diabetes 73% · Heart failure 49% · Coronary heart disease 43% · Atrial fibrillation 35% · COPD 29% · Depression 21% · Stroke 21% · Dementia 14% · Cancer 13%.

The office billed $169,280, Medicare allowed $98,538 and paid $74,148; for 617 services of 15 kinds.

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

Original Medicare by year
2024168617744.22$169,280$74,148
2023191747753.92$190,375$108,200
2022232950754.01$265,850$164,779
20212251,009733.87$291,910$180,753
20202941,377744.06$353,010$177,683
20194642,415733.89$529,260$275,507
20184942,658733.77$591,380$310,955
20175062,528733.93$578,290$295,620
20165483,520724.10$736,600$378,720
20155723,378723.66$638,870$380,670
20145683,683723.65$687,050$416,183
20137084,251723.50$682,270$407,831

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: 7 services

Original Medicare services billed in 2023
Dialysis services, 4 or more physician visits per month (20 years or older)28$57,205$282
Return visit (30+ min)68$16,319$91
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes80$11,850$63
Dialysis services, 2-3 physician visits per month (20 years or older)19$8,468$235
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes35$3,698$95
Short return visit (20+ min)28$2,768$66
Initial hospital care with moderate level of medical decision making at least 75 minutes19$2,682$134

2022: 8 services

Original Medicare services billed in 2022
Dialysis services, 4 or more physician visits per month (20 years or older)45$100,358$292
Return visit (30+ min)78$19,639$96
Dialysis services, 2-3 physician visits per month (20 years or older)34$17,100$241
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes90$9,639$57
Initial hospital care with moderate level of medical decision making at least 75 minutes29$4,950$160
Short return visit (20+ min)32$3,356$68
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes27$2,220$82
Hemodialysis procedure with physician evaluation11$647$59

2021: 8 services

Original Medicare services billed in 2021
Dialysis services, 4 or more physician visits per month (20 years or older)43$101,737$294
Dialysis services, 2-3 physician visits per month (20 years or older)45$30,911$245
Return visit (30+ min)85$15,612$89
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes86$8,622$58
Dialysis services, 1 physician visit per month (20 years or older)15$6,069$169
Initial hospital care with moderate level of medical decision making at least 75 minutes31$5,375$163
Short return visit (20+ min)45$4,769$68
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes34$2,963$82

2020: 10 services

Original Medicare services billed in 2020
Dialysis services, 4 or more physician visits per month (20 years or older)54$91,587$224
Return visit (30+ min)106$19,805$73
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes114$17,915$57
Dialysis services, 2-3 physician visits per month (20 years or older)43$17,777$185
Initial hospital care with moderate level of medical decision making at least 75 minutes68$12,127$157
Dialysis services, 1 physician visit per month (20 years or older)15$4,371$146
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes40$3,579$81
Short return visit (20+ min)48$3,513$56
Hemodialysis procedure with physician evaluation12$1,544$57
Hemodialysis procedure requiring repeated evaluation12$1,480$82

2019: 14 services

Original Medicare services billed in 2019
Dialysis services, 4 or more physician visits per month (20 years or older)66$107,725$230
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes207$44,349$58
Initial hospital care with moderate level of medical decision making at least 75 minutes151$30,343$161
Return visit (30+ min)165$29,162$76
Dialysis services, 2-3 physician visits per month (20 years or older)47$20,865$191
Short return visit (20+ min)100$9,157$55
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes77$7,390$84
Dialysis services, 1 physician visit per month (20 years or older)16$6,804$145
Hemodialysis procedure requiring repeated evaluation32$4,337$83
Hemodialysis procedure with physician evaluation23$3,858$58
Long return visit (40+ min)23$2,461$107
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes14$2,316$110
New patient visit (60+ min)11$1,530$139
New patient visit (45+ min)11$1,233$112

2018: 13 services

Original Medicare services billed in 2018
Dialysis services, 4 or more physician visits per month (20 years or older)74$119,595$230
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes222$49,118$59
Return visit (30+ min)179$34,053$83
Dialysis services, 2-3 physician visits per month (20 years or older)55$28,888$191
Initial hospital care with moderate level of medical decision making at least 75 minutes150$28,684$164
Short return visit (20+ min)105$11,322$57
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes86$8,939$84
Dialysis services, 1 physician visit per month (20 years or older)17$6,623$151
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes27$4,301$110
New patient visit (60+ min)22$3,446$157
Hemodialysis procedure requiring repeated evaluation22$3,442$80
Hemodialysis procedure with physician evaluation26$2,945$59
Long return visit (40+ min)13$1,427$110

2017: 11 services

Original Medicare services billed in 2017
Dialysis services, 4 or more physician visits per month (20 years or older)85$136,453$226
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes219$38,414$57
Return visit (30+ min)178$29,478$77
Dialysis services, 2-3 physician visits per month (20 years or older)54$24,162$190
Initial hospital care with moderate level of medical decision making at least 75 minutes112$18,925$160
Short return visit (20+ min)139$15,990$53
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes90$9,038$83
Dialysis services, 1 physician visit per month (20 years or older)19$4,998$147
Hemodialysis procedure requiring repeated evaluation27$4,219$83
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes22$3,254$108
Hemodialysis procedure with physician evaluation30$3,158$57

2016: 13 services

Original Medicare services billed in 2016
Dialysis services, 4 or more physician visits per month (20 years or older)88$137,705$227
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes245$62,707$57
Dialysis services, 2-3 physician visits per month (20 years or older)90$43,606$191
Return visit (30+ min)197$27,667$75
Short return visit (20+ min)184$23,410$56
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes131$20,636$108
Dialysis services, 1 physician visit per month (20 years or older)35$12,873$148
Initial hospital care with moderate level of medical decision making at least 75 minutes72$12,130$160
Hemodialysis procedure with physician evaluation59$10,762$58
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes72$8,257$83
Hemodialysis procedure requiring repeated evaluation36$5,796$83
New patient visit (45+ min)22$2,902$132
New patient visit (60+ min)11$1,534$139

2015: 13 services

Original Medicare services billed in 2015
Dialysis services, 4 or more physician visits per month (20 years or older)88$126,866$228
Dialysis services, 2-3 physician visits per month (20 years or older)105$59,006$192
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes241$52,195$58
Return visit (30+ min)207$28,973$80
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes121$24,133$84
Short return visit (20+ min)173$20,772$57
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes110$17,396$110
Initial hospital care with moderate level of medical decision making at least 75 minutes87$14,517$161
Dialysis services, 1 physician visit per month (20 years or older)31$13,745$149
Hemodialysis procedure with physician evaluation51$7,532$58
Hemodialysis procedure requiring repeated evaluation33$4,698$84
New patient visit (45+ min)11$1,471$134
Long return visit (40+ min)13$1,188$91

2014: 14 services

Original Medicare services billed in 2014
Dialysis services, 4 or more physician visits per month (20 years or older)100$161,801$229
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes245$62,598$58
Dialysis services, 2-3 physician visits per month (20 years or older)72$36,461$192
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes135$30,737$84
Return visit (30+ min)168$29,936$83
Initial hospital care with moderate level of medical decision making at least 75 minutes136$25,274$159
Short return visit (20+ min)159$20,519$57
Dialysis services, 1 physician visit per month (20 years or older)36$13,280$148
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes85$13,020$106
Hemodialysis procedure with physician evaluation37$6,717$59
Long return visit (40+ min)22$2,683$117
Hemodialysis procedure requiring repeated evaluation18$2,368$85
New patient visit (60+ min)11$1,580$144
New patient visit (45+ min)11$1,362$124

2013: 15 services

Original Medicare services billed in 2013
Dialysis services, 4 or more physician visits per month (20 years or older)86$110,299$227
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes345$91,371$56
Dialysis services, 2-3 physician visits per month (20 years or older)89$38,048$191
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes205$31,281$81
Return visit (30+ min)187$28,290$79
Short return visit (20+ min)200$22,656$54
Initial hospital care with moderate level of medical decision making at least 75 minutes121$19,817$154
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes146$19,805$105
Hemodialysis procedure with physician evaluation61$10,668$57
Dialysis services, 1 physician visit per month (20 years or older)30$10,631$148
Hemodialysis procedure requiring repeated evaluation54$7,453$82
New patient visit (60+ min)14$2,094$150
New patient visit (45+ min)15$1,880$125
Long return visit (40+ min)15$1,744$116
Insertion of non-tunneled central venous tube for infusion (5 years or older)12$1,144$95

Medicaid work

$48,243 in 2024

Medicaid paid $48,243 for 256 billed services this clinician did in 2024, up to 23 people in a month for one service.

Medicaid and CHIP claims where this clinician did the service, fee-for-service and managed care together. Any month with fewer than 11 patients is hidden, so small Medicaid practices undercount.

Largest Medicaid services in 2024
End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month202$40,714
Clinic visit/encounter, all-inclusive42$7,030
Return visit (30+ min)12$499
Medicaid work by year
2024256323$48,243
2023543430$80,759
2022409433$74,019
2021655636$99,248
2020833748$97,733
20191,731851$128,157
20181,954859$147,751
See the largest Medicaid services in earlier years

2023

Largest Medicaid services in 2023
End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month281$62,392
Clinic visit/encounter, all-inclusive59$9,535
SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES162$6,922
Return visit (30+ min)41$1,910

2022

Largest Medicaid services in 2022
End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month349$68,457
Clinic visit/encounter, all-inclusive26$4,040
SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES22$763
Return visit (30+ min)12$759

2021

Largest Medicaid services in 2021
End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month359$69,868
Clinic visit/encounter, all-inclusive131$20,354
End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 2-3 face-to-face visits by a physician or other qualified health care professional per month49$7,242
Return visit (30+ min)29$1,416
SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES22$368
Short return visit (20+ min)65$0

2020

Largest Medicaid services in 2020
End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month492$68,528
Clinic visit/encounter, all-inclusive112$17,189
End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 2-3 face-to-face visits by a physician or other qualified health care professional per month39$5,125
SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES91$3,444
Return visit (30+ min)75$2,402
1ST HOSP IP/OBS HIGH 7512$1,045
Short return visit (20+ min)12$0

2019

Largest Medicaid services in 2019
End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month525$67,278
Clinic visit/encounter, all-inclusive180$27,488
SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES671$16,255
1ST HOSP IP/OBS HIGH 7593$5,926
Return visit (30+ min)157$5,059
End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 2-3 face-to-face visits by a physician or other qualified health care professional per month33$3,264
Short return visit (20+ min)42$1,559
SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES30$1,328

2018

Largest Medicaid services in 2018
End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month560$65,394
Clinic visit/encounter, all-inclusive224$34,030
SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES736$19,635
End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 2-3 face-to-face visits by a physician or other qualified health care professional per month129$15,413
1ST HOSP IP/OBS HIGH 7593$6,080
Return visit (30+ min)148$4,931
Short return visit (20+ min)51$1,943
SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES13$325

Drugs they prescribed that Part D paid

$48,492

Pharmacies billed $48,492 in 2024.

This is pharmacy cost, not the office bill, and not what patients paid.

426 generic and fewer than 11 brand-name prescriptions · $48,492 in drug cost.

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.

Largest Part D drug costs
Prosol53$9,994$189
Sevelamer Carbonate13$1,922$148
Calcium Acetate21$1,005$48
Nifedipine Er13$538$41
Furosemide49$410$8
See all 14 drugs
Every Part D drug this clinician prescribed
Prosol53$9,994$189
Sevelamer Carbonate13$1,922$148
Calcium Acetate21$1,005$48
Nifedipine Er13$538$41
Furosemide49$410$8
Allopurinol28$359$13
Calcitriol19$354$19
Hydralazine27$281$10
Metoprolol13$194$15
Lisinopril28$161$6
Atorvastatin20$161$8
Losartan28$160$6
Amlodipine Besylate47$144$3
Prednisone14$99$7

Year by year

Part D prescribing by year
202452983NoneNone$48,492
202352291NoneNone$81,949
2022813100NoneNone$111,369
20211,067127NoneNone$91,518
20201,264156NoneNone$150,222
20191,569184NoneNone$224,448
20182,540199None19%$435,960
20173,1232071% (15)25%$652,302
20164,0982591% (56)27%$900,944
20153,7652562% (68)27%$724,011
20143,6852342% (62)28%$675,342
20133,2792163% (89)28%$469,631

Part D prescriptions only. A drug prescribed to fewer than 11 people in a year is hidden.

See the drugs prescribed each year

2023: 15 drugs

Part D drugs prescribed in 2023
Cinacalcet11$19,954$1,814
Sevelamer Carbonate16$5,129$321
Calcium Acetate17$3,292$194
Nifedipine Er23$1,065$46
Furosemide47$925$20
Calcitriol18$907$50
Hydralazine23$743$32
Amlodipine Besylate42$634$15
Allopurinol20$471$24
Lisinopril18$376$21
Atorvastatin37$369$10
Losartan26$280$11
Lorazepam12$244$20
Valsartan12$186$15
Prednisone11$151$14

2022: 25 drugs

Part D drugs prescribed in 2022
Velphoro19$36,593$1,926
Sevelamer Carbonate48$20,686$431
Prosol57$7,778$136
Calcium Acetate33$4,520$137
Calcitriol29$1,675$58
Furosemide83$1,002$12
Gabapentin20$966$48
Nifedipine Er17$779$46
Losartan57$659$12
Hydralazine24$618$26
Amlodipine Besylate55$485$9
Isosorbide Mononitrate Er13$472$36
Allopurinol21$437$21
Metoprolol12$365$30
Minoxidil18$351$19
Valsartan11$330$30
Carvedilol14$303$22
Clonidine19$303$16
Lorazepam12$182$15
Atorvastatin38$173$5
Metoprolol28$166$6
Glipizide Er11$83$8
Prednisone15$68$5
Atenolol12$65$5
Hydrochlorothiazide11$32$3

2021: 27 drugs

Part D drugs prescribed in 2021
Sevelamer Carbonate81$12,879$159
Renvela12$11,312$943
Prosol52$9,028$174
Cinacalcet17$6,641$391
Calcium Acetate42$5,945$142
Nifedipine Er53$2,242$42
Calcitriol42$1,832$44
Hydralazine53$921$17
Furosemide108$824$8
Losartan58$675$12
Amlodipine Besylate68$609$9
Allopurinol33$404$12
Minoxidil16$399$25
Gabapentin19$377$20
Metoprolol23$370$16
Lisinopril31$325$10
Clonidine19$273$14
Carvedilol19$233$12
Metoprolol30$152$5
Metformin14$106$8
Atorvastatin22$104$5
Lorazepam13$94$7
Clopidogrel16$89$6
Glipizide Er11$88$8
Prednisone16$76$5
Hydrochlorothiazide21$61$3
Atenolol19$59$3

2020: 31 drugs

Part D drugs prescribed in 2020
Renvela30$39,463$1,315
Sevelamer Carbonate60$25,169$419
Januvia16$12,718$795
Prosol52$8,133$156
Cinacalcet13$7,128$548
Calcium Acetate60$6,890$115
Nifedipine Er79$3,436$43
Calcitriol58$2,244$39
Sodium Polystyrene Sulfonate11$915$83
Hydralazine43$685$16
Losartan68$667$10
Allopurinol39$654$17
Furosemide83$532$6
Atorvastatin41$500$12
Amlodipine Besylate77$492$6
Metoprolol19$455$24
Clonidine27$426$16
Lisinopril51$327$6
Carvedilol37$287$8
Gabapentin32$247$8
Metformin12$116$10
Tamsulosin13$111$9
Metoprolol15$96$6
Hydrochlorothiazide17$83$5
Glipizide Er11$83$8
Atenolol20$75$4
Clopidogrel13$74$6
Famotidine11$69$6
Prednisone23$68$3
Lorazepam11$67$6
Glipizide11$30$3

2019: 35 drugs

Part D drugs prescribed in 2019
Renvela66$106,765$1,618
Sevelamer Carbonate65$24,823$382
Januvia26$17,481$672
Sensipar12$9,896$825
Prosol42$6,918$165
Nifedipine Er97$4,481$46
Calcium Acetate39$3,590$92
Calcitriol90$2,410$27
Allopurinol46$1,041$23
Amlodipine Besylate117$861$7
Atorvastatin46$786$17
Hydralazine51$739$14
Metoprolol20$707$35
Gabapentin44$697$16
Losartan84$617$7
Carvedilol41$587$14
Furosemide110$556$5
Clonidine37$536$14
Bumetanide11$528$48
Lisinopril64$497$8
Tamsulosin19$446$23
Simvastatin24$370$15
Levothyroxine16$358$22
Valsartan13$358$28
Glimepiride17$216$13
Lorazepam13$213$16
Pantoprazole12$191$16
Labetalol11$152$14
Metformin13$137$11
Clopidogrel11$129$12
Benazepril12$128$11
Atenolol31$116$4
Metoprolol29$104$4
Famotidine12$98$8
Hydrochlorothiazide17$53$3

2018: 44 drugs

Part D drugs prescribed in 2018
Renvela150$255,789$1,705
Sevelamer Carbonate66$51,816$785
Sensipar18$19,198$1,067
Januvia38$16,429$432
Prosol50$7,881$158
Nifedipine Er146$5,520$38
Lantus17$4,520$266
Calcium Acetate66$4,218$64
Colchicine11$3,970$361
Calcitriol107$3,168$30
Metoprolol46$1,599$35
Hydralazine78$1,308$17
Tamsulosin44$1,146$26
Atorvastatin95$985$10
Amlodipine Besylate150$973$6
Allopurinol64$904$14
Losartan141$865$6
Metolazone11$848$77
Gabapentin93$795$9
Clonidine69$748$11
Furosemide105$565$5
Levothyroxine25$555$22
Carvedilol92$537$6
Valsartan14$429$31
Omeprazole48$397$8
Isosorbide Mononitrate Er18$382$21
Potassium Chloride14$340$24
Simvastatin37$333$9
Glimepiride27$321$12
Lisinopril49$286$6
Pantoprazole25$220$9
Metoprolol54$214$4
Enalapril Maleate11$211$19
Amitriptyline15$179$12
Atenolol55$170$3
Metformin28$161$6
Clopidogrel30$149$5
Minoxidil11$143$13
Benazepril11$128$12
Hydroxyzine11$127$12
Prednisone20$124$6
Famotidine18$101$6
Sertraline18$68$4
Glipizide14$19$1

2017: 55 drugs

Part D drugs prescribed in 2017
Renvela212$319,258$1,506
Sensipar97$175,029$1,804
Lantus53$16,638$314
Intralipid47$16,353$348
Januvia32$12,783$399
Lantus Solostar20$8,938$447
Byetta12$8,121$677
Calcium Acetate60$7,370$123
Calcitriol173$6,143$36
Nifedipine Er166$5,348$32
Novolog12$4,115$343
Ranexa11$3,786$344
Prosol11$3,236$294
Bumetanide15$1,682$112
Metoprolol71$1,397$20
Tamsulosin50$1,146$23
Amlodipine Besylate251$1,104$4
Hydralazine93$1,065$11
Insulin23$1,006$44
Metolazone17$939$55
Allopurinol67$890$13
Levothyroxine49$743$15
Atorvastatin91$701$8
Clonidine73$691$9
Furosemide157$684$4
Labetalol18$657$36
Potassium Chloride24$643$27
Losartan115$621$5
Phenytoin Sodium Extended13$465$36
Carvedilol103$449$4
Lisinopril79$394$5
Simvastatin60$389$6
Omeprazole67$388$6
Isosorbide Mononitrate Er19$342$18
Glimepiride19$337$18
Gabapentin66$296$4
Amitriptyline25$276$11
Metoprolol71$269$4
Minoxidil14$206$15
Pioglitazone15$202$13
Benazepril11$201$18
Spironolactone14$188$13
Metformin22$177$8
Pantoprazole21$166$8
Hydroxyzine11$133$12
Enalapril Maleate16$120$7
Prednisone15$120$8
Clopidogrel26$96$4
Atenolol42$95$2
Metoclopramide16$90$6
Famotidine22$75$3
Alendronate13$72$6
Nortriptyline12$52$4
Sertraline15$40$3
Glipizide17$40$2

2016: 58 drugs

Part D drugs prescribed in 2016
Renvela314$520,960$1,659
Sensipar138$176,278$1,277
Intralipid61$21,329$350
Lantus48$18,460$385
Renagel15$16,166$1,078
Calcium Acetate114$13,747$121
Januvia28$10,409$372
Novolog21$8,207$391
Byetta12$7,225$602
Calcitriol253$7,130$28
Prosol36$5,916$164
Lantus Solostar16$5,874$367
Nifedipine Er147$5,800$39
Uloric16$4,523$283
Metoprolol79$1,792$23
Metolazone23$1,764$77
Tamsulosin51$1,686$33
Hydralazine134$1,685$13
Valsartan11$1,345$122
Nifedical Xl47$1,209$26
Allopurinol90$1,184$13
Amlodipine Besylate304$1,149$4
Losartan172$1,140$7
Atorvastatin135$1,065$8
Bumetanide14$967$69
Potassium Chloride18$931$52
Furosemide187$876$5
Insulin19$754$40
Clonidine62$606$10
Omeprazole96$596$6
Levothyroxine40$575$14
Carvedilol103$528$5
Lisinopril99$510$5
Doxazosin Mesylate19$496$26
Gabapentin84$482$6
Simvastatin84$474$6
Afeditab Cr12$435$36
Labetalol16$430$27
Atenolol90$378$4
Isosorbide Mononitrate Er26$352$14
Hydrocodone-Acetaminophen22$342$16
Metoprolol110$335$3
Pioglitazone23$273$12
Enalapril Maleate23$264$11
Glimepiride11$259$24
Loperamide12$222$18
Metformin27$217$8
Pantoprazole30$201$7
Amitriptyline17$181$11
Famotidine25$150$6
Tramadol34$130$4
Clopidogrel26$124$5
Glipizide44$113$3
Hydroxyzine11$106$10
Sertraline27$87$3
Spironolactone14$79$6
Warfarin11$76$7
Hydrochlorothiazide13$24$2

2015: 60 drugs

Part D drugs prescribed in 2015
Renvela279$416,106$1,491
Sensipar97$78,174$806
Doxercalciferol13$36,107$2,777
Renagel23$34,547$1,502
Lantus47$20,510$436
Januvia20$10,402$520
Calcium Acetate85$10,342$122
Novolog21$8,492$404
Nexium23$7,100$309
Prosol38$6,967$183
Byetta11$6,427$584
Calcitriol256$6,121$24
Uloric20$5,190$260
Nifedipine Er144$4,814$33
Intralipid13$4,618$355
Valsartan18$2,304$128
Hydralazine116$2,051$18
Metoprolol71$1,917$27
Bumetanide19$1,631$86
Novolin R13$1,588$122
Allopurinol102$1,291$13
Tamsulosin31$1,224$39
Amlodipine Besylate243$1,059$4
Afeditab Cr33$955$29
Metolazone20$804$40
Furosemide198$796$4
Losartan141$765$5
Atorvastatin76$759$10
Omeprazole99$676$7
Metoprolol125$583$5
Enalapril Maleate28$573$20
Gabapentin65$559$9
Lisinopril99$531$5
Insulin21$527$25
Labetalol11$523$48
Potassium Chloride22$519$24
Carvedilol87$489$6
Simvastatin95$476$5
Levothyroxine23$444$19
Hydrocodone-Acetaminophen24$439$18
Pioglitazone23$387$17
Atenolol67$377$6
Metformin37$348$9
Isosorbide Mononitrate Er35$302$9
Glimepiride17$286$17
Tramadol43$274$6
Famotidine28$266$10
Warfarin35$263$8
Clonidine27$247$9
Sertraline34$224$7
Clopidogrel29$191$7
Spironolactone28$182$7
Hydroxyzine18$177$10
Glipizide53$159$3
Amitriptyline11$151$14
Pantoprazole21$135$6
Diltiazem11$116$11
Zolpidem13$111$9
Azithromycin15$87$6
Hydrochlorothiazide11$48$4

2014: 67 drugs

Part D drugs prescribed in 2014
Renvela280$355,112$1,268
Sensipar117$74,168$634
Lantus42$16,361$390
Intralipid42$13,667$325
Prosol62$9,891$160
Calcitriol261$9,063$35
Calcium Acetate63$8,703$138
Nifedipine Er125$6,283$50
Januvia16$5,940$371
Nexium22$5,803$264
Diovan24$5,285$220
Novolog16$4,861$304
Colcrys13$4,094$315
Uloric14$3,303$236
Clinisol17$2,955$174
Kionex12$1,620$135
Metoprolol40$1,519$38
Bumetanide14$1,399$100
Sodium Polystyrene Sulfonate11$1,224$111
Amlodipine Besylate172$1,104$6
Hydralazine52$1,067$21
Losartan120$1,058$9
Ventolin Hfa22$1,034$47
Furosemide175$989$6
Potassium Chloride30$872$29
Omeprazole121$821$7
Atorvastatin49$782$16
Pioglitazone27$766$28
Simvastatin100$748$7
Lactulose15$698$47
Labetalol11$680$62
Atenolol118$618$5
Metolazone25$617$25
Carvedilol70$564$8
Levothyroxine43$532$12
Hydrocodone-Acetaminophen23$494$21
Allopurinol72$491$7
Cartia Xt14$491$35
Lisinopril95$470$5
Metformin63$468$7
Isosorbide Mononitrate Er38$414$11
Metoprolol88$393$4
Gabapentin52$371$7
Enalapril Maleate34$364$11
Clonidine39$356$9
Tamsulosin20$353$18
Diphenoxylate-Atropine15$318$21
Sure Comfort11$310$28
Minoxidil12$308$26
Pantoprazole24$299$12
Glimepiride21$288$14
Glipizide45$288$6
Hydroxyzine16$251$16
Famotidine39$250$6
Zolpidem27$237$9
Tramadol38$219$6
Spironolactone28$193$7
Hydrochlorothiazide40$178$4
Paroxetine20$173$9
Sertraline16$146$9
Warfarin21$138$7
Lorazepam22$131$6
Clopidogrel17$127$7
Diltiazem12$102$8
Lovastatin11$97$9
Trazodone13$95$7
Alprazolam11$93$8

2013: 61 drugs

Part D drugs prescribed in 2013
Renvela253$248,748$983
Sensipar111$55,049$496
Renagel12$19,672$1,639
Clinisol50$15,491$310
Calcitriol315$14,410$46
Diovan48$9,800$204
Lantus34$7,823$230
Intralipid20$5,844$292
Nifedipine Er86$5,353$62
Prosol33$4,753$144
Nexium20$4,330$217
Colcrys16$4,312$270
Qvar13$4,185$322
Calcium Acetate29$4,168$144
Pioglitazone27$3,718$138
Januvia11$2,842$258
Serevent Diskus13$2,531$195
Metoprolol55$2,167$39
Losartan113$1,620$14
Omeprazole99$1,577$16
Clopidogrel24$1,401$58
Amlodipine Besylate161$1,311$8
Furosemide178$933$5
Potassium Chloride34$867$25
Simvastatin85$845$10
Atorvastatin33$701$21
Atenolol131$685$5
Hydrocodone-Acetaminophen36$631$18
Metformin64$569$9
Minoxidil13$494$38
Lisinopril75$493$7
Metolazone24$472$20
Levothyroxine46$456$10
Clonidine35$449$13
Hydralazine25$436$17
Carvedilol44$421$10
Tramadol52$399$8
Amlodipine Besylate-Benazepril12$375$31
Paroxetine26$344$13
Hydrochlorothiazide48$335$7
Pantoprazole20$322$16
Cartia Xt11$302$27
Tamsulosin18$297$17
Metoprolol64$297$5
Glipizide28$292$10
Lovastatin23$287$12
Enalapril Maleate45$276$6
Gabapentin19$229$12
Hydroxyzine13$223$17
Allopurinol32$218$7
Sertraline20$214$11
Diphenoxylate-Atropine17$210$12
Isosorbide Mononitrate Er20$198$10
Azithromycin15$144$10
Lorazepam21$144$7
Amiodarone15$136$9
Spironolactone11$114$10
Promethazine13$110$8
Prednisone19$106$6
Warfarin12$102$9
Zolpidem14$68$5

Money from drug and device companies

$12 in 2022

A payment is not proof that care is biased.

Payments by company
Vifor PharmaNone$12
1 payment
  • Education · 2022-05-17 · $12
See the published payment
Every published payment
Vifor PharmaEducation · 2022-05-17None$12

Checkups this office reported

Medicare did not publish checkup rates for this clinician.

Medicare’s overall office score
75.0 / 100
Scores the office’s reporting and systems. It is not a grade for how the doctor treats you.

Professional record

NPI
1275637506
Licence
CA A42706California A42706: Current · expires 2028-04-30
Gender
Male
More record details
Sole proprietor
Yes
Medicaid ID
CA GR0100620
Taxonomy
Federal specialty code 207RN0300X (207RN0300X)
Mailing address
3351 M Street, Ste 125, Merced, CA, 95348
NPI first listed
2006-09-08
NPI last updated
2014-10-08

This is when the NPI record was last certified, not a medical board exam.