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Lori R Guelman, NP

Nurse Practitioner · Stanford

NPI 1689850745

Medicare standing
Clear
Enrolled, allowed to bill and order, not excluded
Plans that list them
1
1 carrier
Office
1

Offices

1 location · Stanford Health Care · 3,152 clinicians in this group

Looking this up.

Hospitals listed: Adventist Health Sonora · Community Hospital of the Monterey Peninsula · Stanford Health Care · Stanford Health Care Tri-Valley. That is not proof they admit you there this week.

Plans that list them

1 plan · 1 carrier

A missing listing does not mean out of network. Directories change, and a listing does not cover every office. Call Lori R Guelman’s office at (650) 723-4000 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
Anthem Full Dual Advantage Aligned (HMO D-SNP)Anthem Blue CrossListedOct 3, 2026

California Medical Board record

Licence C17970 · Cancelled

Licence status: Cancelled · since 1956 · Jefferson Medical College of Thomas Jefferson University.

License has been voluntarily canceled, or the license has been expired for at least five years and has not been renewed. No practice is permitted.

Matched on the licence number without its letter prefix; check the name before relying on it.

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

Hospitals they work in

4 hospitals

These rate the hospital, not this clinician. Most measures at most hospitals are no different from the national rate.

  • Adventist Health SonoraSonora, CAAcute Care Hospital · Voluntary non-profit - Church · No emergency department · Birthing-friendlyPart of Adventist Health, which runs 28 hospitals in 3 statesPatients rate it 3 of 5 · 64% would definitely recommend it
    Overall rating: 3 of 5 starsWorse than the national rate — Postoperative wound dehiscence rate: 3.5 (2.04 to 4.96) · 288 cases, Jul 2022 – Jun 2024Worse than the national rate — Ratio of unplanned hospital visits after hospital outpatient surgery: 1.3 (1 to 1.6) · 1,004 cases, Jan 2024 – Dec 2024Better than the national rate — Clostridium Difficile (C.Diff): 0.185, Oct 2024 – Sep 2025
  • Community Hospital of the Monterey PeninsulaMonterey, CAAcute Care Hospital · Voluntary non-profit - Private · Has an emergency department · Birthing-friendlyPart of Montage HealthPatients rate it 4 of 5 · 84% would definitely recommend it
    Overall rating: 4 of 5 starsWorse than the national rate — CMS Medicare PSI 90: Patient safety and adverse events composite: 1.48 (1.22 to 1.74), Jul 2022 – Jun 2024Worse than the national rate — Postoperative acute kidney injury requiring dialysis rate: 3.12 (1.69 to 4.56) · 1,095 cases, Jul 2022 – Jun 2024Worse than the national rate — Postoperative respiratory failure rate: 19.24 (14.17 to 24.3) · 1,118 cases, Jul 2022 – Jun 2024Worse than the national rate — Postoperative sepsis rate: 9.62 (6.42 to 12.82) · 1,086 cases, Jul 2022 – Jun 2024Better than the national rate — Central Line Associated Bloodstream Infection (ICU + select Wards): 0, Oct 2024 – Sep 2025Better than the national rate — Clostridium Difficile (C.Diff): 0.39, Oct 2024 – Sep 2025
  • Stanford Health CareStanford, CAAcute Care Hospital · Voluntary non-profit - Private · Has an emergency departmentPart of Stanford Health Care, which runs 3 hospitalsHome of Stanford Cancer Institute, a National Cancer Institute designated comprehensive cancer centrePatients rate it 4 of 5 · 83% would definitely recommend it
    Overall rating: 5 of 5 starsWorse than the national rate — Perioperative pulmonary embolism or deep vein thrombosis rate: 5.31 (4.24 to 6.37) · 8,661 cases, Jul 2022 – Jun 2024Worse than the national rate — Rate of inpatient admissions for patients receiving outpatient chemotherapy: 14.1 (12.7 to 15.7) · 2,191 cases, Jan 2024 – Dec 2024Better than the national rate — Postoperative respiratory failure rate: 4.08 (1.95 to 6.21) · 5,296 cases, Jul 2022 – Jun 2024Better than the national rate — Catheter Associated Urinary Tract Infections (ICU + select Wards): 0.317, Oct 2024 – Sep 2025Better than the national rate — Clostridium Difficile (C.Diff): 0.446, Oct 2024 – Sep 2025Better than the national rate — SSI - Colon Surgery: 0.241, Oct 2024 – Sep 2025Better than the national rate — Ratio of unplanned hospital visits after hospital outpatient surgery: 0.7 (0.6 to 0.9) · 3,348 cases, Jan 2024 – Dec 2024
  • Stanford Health Care Tri-ValleyPleasanton, CAAcute Care Hospital · Voluntary non-profit - Private · Has an emergency department · Birthing-friendlyPart of Stanford Health Care, which runs 3 hospitalsPatients rate it 3 of 5 · 74% would definitely recommend it
    Overall rating: 5 of 5 starsBetter than the national rate — Central Line Associated Bloodstream Infection (ICU + select Wards): 0.178, Oct 2024 – Sep 2025Better than the national rate — Clostridium Difficile (C.Diff): 0.237, Oct 2024 – Sep 2025
See every measure and the patient survey for Adventist Health Sonora

Behind the star rating — Deaths: 0 better, 7 the same, 0 worse of 7 measures. Safety: 0 better, 4 the same, 0 worse of 4 measures. Readmissions: 1 better, 7 the same, 1 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 Adventist Health Sonora
Postoperative wound dehiscence rateComplications and deaths3.5 (2.04 to 4.96) · 288 casesWorseJul 2022 – Jun 2024
Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits1.3 (1 to 1.6) · 1,004 casesWorseJan 2024 – Dec 2024
Clostridium Difficile (C.Diff)Infections0.185BetterOct 2024 – Sep 2025
Abdominopelvic accidental puncture or laceration rateComplications and deaths1.15 (0.14 to 2.16) · 582 casesNo differentJul 2022 – Jun 2024
CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths0.87 (0.5 to 1.24)No differentJul 2022 – Jun 2024
Death rate among surgical inpatients with serious treatable complicationsComplications and deaths182.91 (123.44 to 242.37) · 38 casesNo differentJul 2022 – Jun 2024
Death rate for COPD patientsComplications and deaths7.9 · 118 casesNoneJul 2022 – Jun 2025
Death rate for heart attack patientsComplications and deaths9 · 125 casesNoneJul 2022 – Jun 2025
Death rate for heart failure patientsComplications and deaths11.7 · 236 casesNoneJul 2022 – Jun 2025
Death rate for pneumonia patientsComplications and deaths15 · 433 casesNoneJul 2022 – Jun 2025
Death rate for stroke patientsComplications and deaths12 · 72 casesNoneJul 2023 – Jun 2025
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths3.9 · 1,364 casesNoneJul 2024 – Jun 2025
Iatrogenic pneumothorax rateComplications and deaths0.18 (0 to 0.39) · 3,671 casesNo differentJul 2022 – Jun 2024
In-hospital fall-associated fracture rateComplications and deaths0.28 (0.07 to 0.48) · 3,602 casesNo differentJul 2022 – Jun 2024
Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths3.41 (1.24 to 5.59) · 803 casesNo differentJul 2022 – Jun 2024
Postoperative acute kidney injury requiring dialysis rateComplications and deaths1.57 (0 to 3.24) · 310 casesNo differentJul 2022 – Jun 2024
Postoperative hemorrhage or hematoma rateComplications and deaths2.59 (0.98 to 4.2) · 754 casesNo differentJul 2022 – Jun 2024
Postoperative respiratory failure rateComplications and deaths7.97 (0 to 16.16) · 306 casesNo differentJul 2022 – Jun 2024
Postoperative sepsis rateComplications and deaths5.72 (1.85 to 9.58) · 277 casesNo differentJul 2022 – Jun 2024
Pressure ulcer rateComplications and deaths0.23 (0 to 1.06) · 2,750 casesNo differentJul 2022 – Jun 2024
Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections0.614No differentOct 2024 – Sep 2025
Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits13.6 · 105 casesNoneJul 2023 – Jun 2025
Heart failure (HF) 30-Day Readmission RateUnplanned return visits19.6 · 209 casesNoneJul 2023 – Jun 2025
Hospital return days for heart attack patientsUnplanned return visits12.6 · 119 casesNoneJul 2022 – Jun 2025
Hospital return days for heart failure patientsUnplanned return visits-23.8 · 255 casesNoneJul 2022 – Jun 2025
Hospital return days for pneumonia patientsUnplanned return visits-13.4 · 455 casesNoneJul 2022 – Jun 2025
Pneumonia (PN) 30-Day Readmission RateUnplanned return visits16.3 · 381 casesNoneJul 2023 – Jun 2025
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits6 (4.3 to 8.1) · 328 casesNo differentJan 2024 – Dec 2024
Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits11.7 (9.1 to 14.7) · 328 casesNo differentJan 2024 – Dec 2024
Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits19.3 · 106 casesNoneJul 2023 – Jun 2025
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits12.8 (10 to 16.3) · 1,835 casesNo differentJan 2022 – Dec 2024

What patients said (326 patients answered, 21% of those asked)

Patient survey stars by topic at Adventist Health Sonora
Cleanliness3
Nurse communication4
Doctor communication3
Communication about medicines3
Discharge information4
Overall hospital rating3
Quietness2
Recommend hospital3
Share of patients giving the best answer at Adventist Health Sonora
Room was "always" clean69%
Nurses "always" communicated well80%
Doctors "always" communicated well77%
Staff "always" explained61%
Yes, staff "did" give patients this information89%
Yes, staff "did" give patients information about help after discharge86%
Doctors "always" explained things so they could understand72%
Doctors "always" listened carefully74%
Doctors "always" treated them with courtesy and respect85%
Patients who gave a rating of "9" or "10" (high)64%
Staff "always" explained new medications73%
Nurses "always" explained things so they could understand75%
Nurses "always" listened carefully76%
Nurses "always" treated them with courtesy and respect89%
"Always" quiet at night44%
"YES", patients would definitely recommend the hospital64%
Staff "always" explained possible side effects50%
Yes, staff "did" give patients information about possible symptoms93%
See every measure and the patient survey for Community Hospital of the Monterey Peninsula

Behind the star rating — Deaths: 2 better, 6 the same, 0 worse of 8 measures. Safety: 1 better, 5 the same, 1 worse of 7 measures. Readmissions: 0 better, 11 the same, 0 worse of 11 measures. The star rating is worked out from an earlier period than the measures below, so the two can disagree.

Every scored measure at Community Hospital of the Monterey Peninsula
CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths1.48 (1.22 to 1.74)WorseJul 2022 – Jun 2024
Postoperative acute kidney injury requiring dialysis rateComplications and deaths3.12 (1.69 to 4.56) · 1,095 casesWorseJul 2022 – Jun 2024
Postoperative respiratory failure rateComplications and deaths19.24 (14.17 to 24.3) · 1,118 casesWorseJul 2022 – Jun 2024
Postoperative sepsis rateComplications and deaths9.62 (6.42 to 12.82) · 1,086 casesWorseJul 2022 – Jun 2024
Central Line Associated Bloodstream Infection (ICU + select Wards)Infections0BetterOct 2024 – Sep 2025
Clostridium Difficile (C.Diff)Infections0.39BetterOct 2024 – Sep 2025
Abdominopelvic accidental puncture or laceration rateComplications and deaths1.27 (0.39 to 2.16) · 1,873 casesNo differentJul 2022 – Jun 2024
Death rate among surgical inpatients with serious treatable complicationsComplications and deaths158.2 (110.65 to 205.75) · 140 casesNo differentJul 2022 – Jun 2024
Death rate for CABG surgery patientsComplications and deaths2.3 · 74 casesNoneJul 2022 – Jun 2025
Death rate for COPD patientsComplications and deaths6.8 · 135 casesNoneJul 2022 – Jun 2025
Death rate for heart attack patientsComplications and deaths10 · 184 casesNoneJul 2022 – Jun 2025
Death rate for heart failure patientsComplications and deaths9.7 · 686 casesNoneJul 2022 – Jun 2025
Death rate for pneumonia patientsComplications and deaths16.4 · 1,072 casesNoneJul 2022 – Jun 2025
Death rate for stroke patientsComplications and deaths8 · 328 casesNoneJul 2023 – Jun 2025
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths2.8 · 3,300 casesNoneJul 2024 – Jun 2025
Iatrogenic pneumothorax rateComplications and deaths0.29 (0.11 to 0.48) · 10,234 casesNo differentJul 2022 – Jun 2024
In-hospital fall-associated fracture rateComplications and deaths0.28 (0.1 to 0.46) · 10,572 casesNo differentJul 2022 – Jun 2024
Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths3.25 (1.47 to 5.04) · 2,617 casesNo differentJul 2022 – Jun 2024
Postoperative hemorrhage or hematoma rateComplications and deaths2.37 (1.04 to 3.7) · 2,519 casesNo differentJul 2022 – Jun 2024
Postoperative wound dehiscence rateComplications and deaths2.21 (0.75 to 3.66) · 744 casesNo differentJul 2022 – Jun 2024
Pressure ulcer rateComplications and deaths0.61 (0.06 to 1.17) · 8,715 casesNo differentJul 2022 – Jun 2024
Rate of complications for hip/knee replacement patientsComplications and deaths5.2 · 156 casesNoneApr 2023 – Mar 2025
Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections0.28No differentOct 2024 – Sep 2025
MRSA BacteremiaInfections0.799No differentOct 2024 – Sep 2025
SSI - Colon SurgeryInfections0.732No differentOct 2024 – Sep 2025
Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits13.7 · 152 casesNoneJul 2023 – Jun 2025
Heart failure (HF) 30-Day Readmission RateUnplanned return visits20.6 · 625 casesNoneJul 2023 – Jun 2025
Hospital return days for heart attack patientsUnplanned return visits6.3 · 193 casesNoneJul 2022 – Jun 2025
Hospital return days for heart failure patientsUnplanned return visits-3.2 · 749 casesNoneJul 2022 – Jun 2025
Hospital return days for pneumonia patientsUnplanned return visits7 · 1,074 casesNoneJul 2022 – Jun 2025
Pneumonia (PN) 30-Day Readmission RateUnplanned return visits18.5 · 850 casesNoneJul 2023 – Jun 2025
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits4 (2.7 to 5.8) · 224 casesNo differentJan 2024 – Dec 2024
Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits13.5 (10.4 to 17.4) · 224 casesNo differentJan 2024 – Dec 2024
Rate of readmission after hip/knee replacementUnplanned return visits5.7 · 153 casesNoneJul 2023 – Jun 2025
Rate of readmission for CABGUnplanned return visits11.5 · 49 casesNoneJul 2023 – Jun 2025
Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits19.3 · 144 casesNoneJul 2023 – Jun 2025
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits14.2 (10.9 to 18.6) · 711 casesNo differentJan 2022 – Dec 2024
Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits1.2 (1 to 1.5) · 746 casesNo differentJan 2024 – Dec 2024

What patients said (520 patients answered, 28% of those asked)

Patient survey stars by topic at Community Hospital of the Monterey Peninsula
Cleanliness4
Nurse communication4
Doctor communication4
Communication about medicines3
Discharge information3
Overall hospital rating5
Quietness3
Recommend hospital5
Share of patients giving the best answer at Community Hospital of the Monterey Peninsula
Room was "always" clean75%
Nurses "always" communicated well82%
Doctors "always" communicated well81%
Staff "always" explained62%
Yes, staff "did" give patients this information86%
Yes, staff "did" give patients information about help after discharge84%
Doctors "always" explained things so they could understand75%
Doctors "always" listened carefully79%
Doctors "always" treated them with courtesy and respect89%
Patients who gave a rating of "9" or "10" (high)82%
Staff "always" explained new medications79%
Nurses "always" explained things so they could understand79%
Nurses "always" listened carefully77%
Nurses "always" treated them with courtesy and respect89%
"Always" quiet at night54%
"YES", patients would definitely recommend the hospital84%
Staff "always" explained possible side effects46%
Yes, staff "did" give patients information about possible symptoms88%
See every measure and the patient survey for Stanford Health Care

Behind the star rating — Deaths: 5 better, 3 the same, 0 worse of 8 measures. Safety: 3 better, 5 the same, 0 worse of 8 measures. Readmissions: 2 better, 5 the same, 4 worse of 11 measures. The star rating is worked out from an earlier period than the measures below, so the two can disagree.

Every scored measure at Stanford Health Care
Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths5.31 (4.24 to 6.37) · 8,661 casesWorseJul 2022 – Jun 2024
Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits14.1 (12.7 to 15.7) · 2,191 casesWorseJan 2024 – Dec 2024
Postoperative respiratory failure rateComplications and deaths4.08 (1.95 to 6.21) · 5,296 casesBetterJul 2022 – Jun 2024
Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections0.317BetterOct 2024 – Sep 2025
Clostridium Difficile (C.Diff)Infections0.446BetterOct 2024 – Sep 2025
SSI - Colon SurgeryInfections0.241BetterOct 2024 – Sep 2025
Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits0.7 (0.6 to 0.9) · 3,348 casesBetterJan 2024 – Dec 2024
Abdominopelvic accidental puncture or laceration rateComplications and deaths1.06 (0.45 to 1.67) · 5,374 casesNo differentJul 2022 – Jun 2024
CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths0.86 (0.72 to 1)No differentJul 2022 – Jun 2024
Death rate among surgical inpatients with serious treatable complicationsComplications and deaths166.09 (137.88 to 194.3) · 470 casesNo differentJul 2022 – Jun 2024
Death rate for CABG surgery patientsComplications and deaths1.1 · 192 casesNoneJul 2022 – Jun 2025
Death rate for COPD patientsComplications and deaths6.4 · 146 casesNoneJul 2022 – Jun 2025
Death rate for heart attack patientsComplications and deaths9.7 · 253 casesNoneJul 2022 – Jun 2025
Death rate for heart failure patientsComplications and deaths6.3 · 880 casesNoneJul 2022 – Jun 2025
Death rate for pneumonia patientsComplications and deaths10.3 · 935 casesNoneJul 2022 – Jun 2025
Death rate for stroke patientsComplications and deaths8.7 · 501 casesNoneJul 2023 – Jun 2025
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths2.1 · 7,730 casesNoneJul 2024 – Jun 2025
Iatrogenic pneumothorax rateComplications and deaths0.13 (0 to 0.27) · 20,799 casesNo differentJul 2022 – Jun 2024
In-hospital fall-associated fracture rateComplications and deaths0.28 (0.14 to 0.43) · 23,182 casesNo differentJul 2022 – Jun 2024
Postoperative acute kidney injury requiring dialysis rateComplications and deaths0.94 (0.2 to 1.68) · 5,694 casesNo differentJul 2022 – Jun 2024
Postoperative hemorrhage or hematoma rateComplications and deaths2.36 (1.54 to 3.19) · 7,846 casesNo differentJul 2022 – Jun 2024
Postoperative sepsis rateComplications and deaths5.2 (3.76 to 6.64) · 5,603 casesNo differentJul 2022 – Jun 2024
Postoperative wound dehiscence rateComplications and deaths1.38 (0.23 to 2.53) · 2,211 casesNo differentJul 2022 – Jun 2024
Pressure ulcer rateComplications and deaths0.52 (0.21 to 0.83) · 19,915 casesNo differentJul 2022 – Jun 2024
Rate of complications for hip/knee replacement patientsComplications and deaths3.6 · 416 casesNoneApr 2023 – Mar 2025
Central Line Associated Bloodstream Infection (ICU + select Wards)Infections0.869No differentOct 2024 – Sep 2025
MRSA BacteremiaInfections0.857No differentOct 2024 – Sep 2025
SSI - Abdominal HysterectomyInfections0.368No differentOct 2024 – Sep 2025
Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits16.2 · 247 casesNoneJul 2023 – Jun 2025
Heart failure (HF) 30-Day Readmission RateUnplanned return visits20.5 · 1,021 casesNoneJul 2023 – Jun 2025
Hospital return days for heart attack patientsUnplanned return visits47.8 · 258 casesNoneJul 2022 – Jun 2025
Hospital return days for heart failure patientsUnplanned return visits-1.6 · 990 casesNoneJul 2022 – Jun 2025
Hospital return days for pneumonia patientsUnplanned return visits20.8 · 976 casesNoneJul 2022 – Jun 2025
Pneumonia (PN) 30-Day Readmission RateUnplanned return visits16.5 · 959 casesNoneJul 2023 – Jun 2025
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits5.2 (4.4 to 6.2) · 2,191 casesNo differentJan 2024 – Dec 2024
Rate of readmission after hip/knee replacementUnplanned return visits5.1 · 425 casesNoneJul 2023 – Jun 2025
Rate of readmission for CABGUnplanned return visits9.6 · 158 casesNoneJul 2023 – Jun 2025
Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits19.6 · 183 casesNoneJul 2023 – Jun 2025
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits12.7 (10.4 to 15.4) · 4,578 casesNo differentJan 2022 – Dec 2024

What patients said (6,810 patients answered, 25% of those asked)

Patient survey stars by topic at Stanford Health Care
Cleanliness4
Nurse communication4
Doctor communication4
Communication about medicines3
Discharge information4
Overall hospital rating4
Quietness2
Recommend hospital5
Share of patients giving the best answer at Stanford Health Care
Room was "always" clean75%
Nurses "always" communicated well82%
Doctors "always" communicated well81%
Staff "always" explained63%
Yes, staff "did" give patients this information89%
Yes, staff "did" give patients information about help after discharge89%
Doctors "always" explained things so they could understand76%
Doctors "always" listened carefully80%
Doctors "always" treated them with courtesy and respect87%
Patients who gave a rating of "9" or "10" (high)79%
Staff "always" explained new medications76%
Nurses "always" explained things so they could understand77%
Nurses "always" listened carefully79%
Nurses "always" treated them with courtesy and respect88%
"Always" quiet at night53%
"YES", patients would definitely recommend the hospital83%
Staff "always" explained possible side effects50%
Yes, staff "did" give patients information about possible symptoms90%
See every measure and the patient survey for Stanford Health Care Tri-Valley

Behind the star rating — Deaths: 2 better, 6 the same, 0 worse of 8 measures. Safety: 2 better, 5 the same, 0 worse of 7 measures. Readmissions: 2 better, 7 the same, 0 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 Stanford Health Care Tri-Valley
Central Line Associated Bloodstream Infection (ICU + select Wards)Infections0.178BetterOct 2024 – Sep 2025
Clostridium Difficile (C.Diff)Infections0.237BetterOct 2024 – Sep 2025
Abdominopelvic accidental puncture or laceration rateComplications and deaths0.79 (0 to 1.73) · 1,041 casesNo differentJul 2022 – Jun 2024
CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths0.79 (0.5 to 1.08)No differentJul 2022 – Jun 2024
Death rate among surgical inpatients with serious treatable complicationsComplications and deaths145.81 (96.5 to 195.12) · 72 casesNo differentJul 2022 – Jun 2024
Death rate for CABG surgery patientsComplications and deaths2.9 · 55 casesNoneJul 2022 – Jun 2025
Death rate for COPD patientsComplications and deaths8.6 · 92 casesNoneJul 2022 – Jun 2025
Death rate for heart attack patientsComplications and deaths12.5 · 96 casesNoneJul 2022 – Jun 2025
Death rate for heart failure patientsComplications and deaths9.5 · 395 casesNoneJul 2022 – Jun 2025
Death rate for pneumonia patientsComplications and deaths10.3 · 391 casesNoneJul 2022 – Jun 2025
Death rate for stroke patientsComplications and deaths10.1 · 162 casesNoneJul 2023 – Jun 2025
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths3 · 1,736 casesNoneJul 2024 – Jun 2025
Iatrogenic pneumothorax rateComplications and deaths0.16 (0 to 0.37) · 4,425 casesNo differentJul 2022 – Jun 2024
In-hospital fall-associated fracture rateComplications and deaths0.22 (0.02 to 0.41) · 4,771 casesNo differentJul 2022 – Jun 2024
Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths3.45 (1.46 to 5.44) · 1,403 casesNo differentJul 2022 – Jun 2024
Postoperative acute kidney injury requiring dialysis rateComplications and deaths1.5 (0.05 to 2.94) · 645 casesNo differentJul 2022 – Jun 2024
Postoperative hemorrhage or hematoma rateComplications and deaths1.81 (0.38 to 3.24) · 1,279 casesNo differentJul 2022 – Jun 2024
Postoperative respiratory failure rateComplications and deaths8.53 (3.2 to 13.85) · 639 casesNo differentJul 2022 – Jun 2024
Postoperative sepsis rateComplications and deaths5.15 (1.89 to 8.41) · 648 casesNo differentJul 2022 – Jun 2024
Postoperative wound dehiscence rateComplications and deaths1.61 (0.14 to 3.07) · 370 casesNo differentJul 2022 – Jun 2024
Pressure ulcer rateComplications and deaths0.16 (0 to 0.83) · 4,160 casesNo differentJul 2022 – Jun 2024
Rate of complications for hip/knee replacement patientsComplications and deaths4 · 74 casesNoneApr 2023 – Mar 2025
Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections0.369No differentOct 2024 – Sep 2025
MRSA BacteremiaInfections1.112No differentOct 2024 – Sep 2025
SSI - Colon SurgeryInfections0No differentOct 2024 – Sep 2025
Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits13.1 · 110 casesNoneJul 2023 – Jun 2025
Heart failure (HF) 30-Day Readmission RateUnplanned return visits20.1 · 437 casesNoneJul 2023 – Jun 2025
Hospital return days for heart attack patientsUnplanned return visits-5.8 · 94 casesNoneJul 2022 – Jun 2025
Hospital return days for heart failure patientsUnplanned return visits-19.3 · 456 casesNoneJul 2022 – Jun 2025
Hospital return days for pneumonia patientsUnplanned return visits-0.3 · 402 casesNoneJul 2022 – Jun 2025
Pneumonia (PN) 30-Day Readmission RateUnplanned return visits15.8 · 358 casesNoneJul 2023 – Jun 2025
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits6.8 (4.7 to 9.6) · 198 casesNo differentJan 2024 – Dec 2024
Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits10.1 (7.5 to 13.6) · 198 casesNo differentJan 2024 – Dec 2024
Rate of readmission after hip/knee replacementUnplanned return visits5.3 · 80 casesNoneJul 2023 – Jun 2025
Rate of readmission for CABGUnplanned return visits10.9 · 46 casesNoneJul 2023 – Jun 2025
Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits19.3 · 92 casesNoneJul 2023 – Jun 2025
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits12.4 (9.6 to 16.2) · 1,532 casesNo differentJan 2022 – Dec 2024
Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits1 (0.8 to 1.2) · 929 casesNo differentJan 2024 – Dec 2024

What patients said (1,268 patients answered, 26% of those asked)

Patient survey stars by topic at Stanford Health Care Tri-Valley
Cleanliness3
Nurse communication3
Doctor communication4
Communication about medicines3
Discharge information4
Overall hospital rating3
Quietness2
Recommend hospital4
Share of patients giving the best answer at Stanford Health Care Tri-Valley
Room was "always" clean65%
Nurses "always" communicated well77%
Doctors "always" communicated well79%
Staff "always" explained58%
Yes, staff "did" give patients this information88%
Yes, staff "did" give patients information about help after discharge88%
Doctors "always" explained things so they could understand74%
Doctors "always" listened carefully78%
Doctors "always" treated them with courtesy and respect86%
Patients who gave a rating of "9" or "10" (high)70%
Staff "always" explained new medications72%
Nurses "always" explained things so they could understand73%
Nurses "always" listened carefully74%
Nurses "always" treated them with courtesy and respect84%
"Always" quiet at night42%
"YES", patients would definitely recommend the hospital74%
Staff "always" explained possible side effects44%
Yes, staff "did" give patients information about possible symptoms89%

Original Medicare doctor bills

$27,082

Medicare paid this office $27,082 for 296 people.

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

Largest Original Medicare bills
Short return visit (20+ min)86$6,156$64
Biopsy of prostate gland51$4,867$95
Return visit (30+ min)44$4,408$100
New patient visit (60+ min)15$1,539$103
Instillation of anti-cancer drug into bladder21$1,508$31
See all 11 services
Every Original Medicare service billed
Short return visit (20+ min)86$6,156$64
Biopsy of prostate gland51$4,867$95
Return visit (30+ min)44$4,408$100
New patient visit (60+ min)15$1,539$103
Instillation of anti-cancer drug into bladder21$1,508$31
Simple removal of foreign body, stone, or stent in urethra or bladder using an endoscope14$1,406$100
Return visit (30+ min)15$1,119$70
Insertion of temporary bladder tube16$721$18
Ultrasound scan of pelvic region through rectum25$624$25
Short return visit (20+ min)16$605$36
Insertion of temporary bladder tube15$340$15

Who their Medicare patients are

296 Original Medicare patients in 2024. Average age 74 · Under 65 4% · 85 and older 7% · Women 12% · Also on Medicaid 15% · Health risk score 1.50. Above the middle of the specialty; the typical nurse practitioner clinician is at 1.42.

Conditions among them: High blood pressure 71% · Cancer 67% · Coronary heart disease 29% · Diabetes 26% · Chronic kidney disease 24% · Atrial fibrillation 18% · Heart failure 12% · Depression 11% · COPD 8% · Stroke 6%.

The office billed $223,774, Medicare allowed $37,499 and paid $27,082; for 444 services of 19 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
2024296444741.50$223,774$27,082
2023271365722.02$193,823$22,978
2022208333721.54$154,972$20,283
2021129183741.06$103,289$14,340
2020135170741.61$46,106$6,625
2019389769751.70$146,349$27,396
2018390877751.60$184,283$28,785
2017357825731.46$158,087$24,569
2016316754741.45$158,198$23,627
2015337776731.67$148,156$26,685
2014335896731.50$170,364$31,332
2013251772711.46$169,299$23,769

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: 9 services

Original Medicare services billed in 2023
Return visit (30+ min)60$4,691$69
New patient visit (60+ min)30$3,729$124
Short return visit (20+ min)66$3,669$48
Biopsy of prostate gland34$3,371$99
Simple removal of foreign body, stone, or stent in urethra or bladder using an endoscope29$3,249$112
Long return visit (40+ min)11$1,331$111
Instillation of anti-cancer drug into bladder18$679$25
Ultrasonic guidance for needle placement23$542$24
Short return visit11$306$28

2022: 5 services

Original Medicare services billed in 2022
Return visit (30+ min)74$6,077$65
New patient visit (60+ min)32$3,945$123
Short return visit (20+ min)57$3,193$46
Instillation of anti-cancer drug into bladder26$2,334$33
Long return visit (40+ min)19$2,055$108

2021: 3 services

Original Medicare services billed in 2021
Return visit (30+ min)64$6,330$68
New patient visit (60+ min)31$3,911$126
Long return visit (40+ min)23$2,675$107

2020: 4 services

Original Medicare services billed in 2020
Short return visit (20+ min)58$1,936$33
New patient visit (45+ min)14$1,431$102
Return visit (30+ min)30$1,266$42
Insertion of lower leg neurostimulator electrode13$510$17

2019: 6 services

Original Medicare services billed in 2019
Short return visit (20+ min)232$10,858$36
Return visit (30+ min)111$6,952$56
Insertion of lower leg neurostimulator electrode27$3,173$21
New patient visit (30+ min)56$3,030$54
Simple change of bladder tube11$1,480$39
Short return visit40$1,041$18

2018: 7 services

Original Medicare services billed in 2018
Short return visit (20+ min)206$9,057$36
Return visit (30+ min)107$7,156$56
Insertion of lower leg neurostimulator electrode29$4,366$22
Short return visit87$2,455$17
New patient visit (30+ min)37$2,037$55
Simple change of bladder tube14$1,676$40
Electronic assessment of bladder emptying23$142$6

2017: 7 services

Original Medicare services billed in 2017
Short return visit (20+ min)194$8,171$34
Return visit (30+ min)81$4,431$52
Short return visit133$3,396$18
Insertion of lower leg neurostimulator electrode25$3,213$22
New patient visit (30+ min)32$1,674$52
Electronic analysis of implanted neurostimulator generator with simple spinal cord or peripheral nerve stimulator programming11$433$29
Electronic assessment of bladder emptying16$97$5

2016: 6 services

Original Medicare services billed in 2016
Short return visit (20+ min)186$7,943$35
Return visit (30+ min)74$5,012$56
Insertion of lower leg neurostimulator electrode18$3,056$21
Short return visit97$2,427$17
New patient visit (30+ min)28$1,499$54
Electronic assessment of bladder emptying23$139$6

2015: 6 services

Original Medicare services billed in 2015
Short return visit (20+ min)187$8,084$35
New patient visit (45+ min)71$6,342$89
Return visit (30+ min)67$3,766$54
Short return visit104$3,283$17
Insertion of lower leg neurostimulator electrode11$1,677$22
Electronic assessment of bladder emptying37$238$6

2014: 6 services

Original Medicare services billed in 2014
Short return visit (20+ min)176$8,637$35
New patient visit (45+ min)90$8,005$89
Return visit (30+ min)75$4,769$59
Short return visit103$4,210$18
Insertion of lower leg neurostimulator electrode12$1,782$21
Electronic assessment of bladder emptying50$357$6

2013: 7 services

Original Medicare services billed in 2013
New patient visit (45+ min)64$5,723$89
Short return visit (20+ min)104$4,786$34
Short return visit119$3,243$17
Insertion of lower leg neurostimulator electrode14$3,098$21
Return visit (30+ min)44$2,509$53
Simple bladder irrigation and/or instillation15$2,160$29
Electronic assessment of bladder emptying43$266$6

Medicaid work

$549 in 2019

Medicaid paid $549 for 79 billed services this clinician did in 2019, up to 13 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 2019
Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging66$479
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy13$70
Medicaid work by year
201979213$549
201891222$543
See the largest Medicaid services in earlier years

2018

Largest Medicaid services in 2018
Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging76$461
Hospital outpatient clinic visit for assessment and management of a patient15$82

Drugs they prescribed that Part D paid

$9,425

Pharmacies billed $9,425 in 2024.

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

Opioids were 0% of their Part D prescriptions (0 of 254) in 2024. At or below the middle of the specialty; the typical nurse practitioner clinician is at 0%.

246 generic and fewer than 11 brand-name prescriptions · $9,425 in drug cost · 58 antibiotic prescriptions to 47 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.

Largest Part D drug costs
Tamsulosin54$1,881$18
Finasteride26$841$15
Nitrofurantoin Mono-Macro11$183$17
Amoxicillin-Clavulanate Potass13$90$6
Cephalexin12$48$4

Year by year

Part D prescribing by year
20242541430% (0)None$9,425
202313286NoneNone$6,108
202210466NoneNone$3,387
202110968NoneNone$5,424
20204851690% (0)None$109,070
20191,300302NoneNone$283,026
20181,281289None32%$213,678
20171,101271None27%$166,192
20161,089251NoneNone$160,167
20151,0802320% (0)None$153,548
2014898201NoneNone$108,838
2013646159NoneNone$83,515

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

See the drugs prescribed each year

2023: 3 drugs

Part D drugs prescribed in 2023
Tamsulosin65$1,924$30
Finasteride13$208$16
Sulfamethoxazole-Trimethoprim12$66$5

2022: 2 drugs

Part D drugs prescribed in 2022
Tamsulosin44$944$21
Finasteride20$386$19

2021: 2 drugs

Part D drugs prescribed in 2021
Tamsulosin59$1,463$25
Finasteride15$572$38

2020: 12 drugs

Part D drugs prescribed in 2020
Myrbetriq75$60,188$803
Estring15$7,272$485
Premarin11$4,276$389
Estradiol11$2,468$224
Methenamine Hippurate22$2,284$104
Trospium Chloride14$2,055$147
Tamsulosin91$1,619$18
Oxybutynin Chloride Er17$1,515$89
Finasteride95$1,410$15
Gentamicin Sulfate15$1,202$80
Cephalexin16$103$6
Sodium Chloride12$42$3

2019: 22 drugs

Part D drugs prescribed in 2019
Myrbetriq244$165,293$677
Elmiron13$25,190$1,938
Premarin51$19,217$377
Methenamine Hippurate79$8,723$110
Estring16$7,181$449
Estrace16$5,575$348
Tamsulosin232$4,577$20
Estradiol16$3,841$240
Finasteride189$3,831$20
Oxybutynin Chloride Er46$2,788$61
Trospium Chloride18$2,273$126
Dutasteride18$2,131$118
Yuvafem13$1,559$120
Testosterone Cypionate12$817$68
Cephalexin99$709$7
Amitriptyline19$536$28
Doxazosin Mesylate16$469$29
Oxybutynin Chloride11$403$37
Nitrofurantoin Mono-Macro23$377$16
Nitrofurantoin11$333$30
Sodium Chloride17$145$9
Sulfamethoxazole-Trimethoprim16$73$5

2018: 25 drugs

Part D drugs prescribed in 2018
Myrbetriq201$102,218$509
Elmiron22$33,094$1,504
Premarin28$11,458$409
Estring26$11,117$428
Vesicare18$8,114$451
Methenamine Hippurate61$5,416$89
Tamsulosin239$4,476$19
Estrace12$4,143$345
Finasteride153$2,889$19
Trospium Chloride24$2,515$105
Oxybutynin Chloride Er47$2,402$51
Estradiol11$2,340$213
Dutasteride16$1,466$92
Yuvafem13$1,397$107
Methenamine Mandelate12$1,135$95
Cephalexin103$890$9
Gentamicin Sulfate17$882$52
Amitriptyline33$762$23
Nitrofurantoin17$430$25
Doxazosin Mesylate19$423$22
Nitrofurantoin Mono-Macro14$279$20
Fluconazole21$177$8
Sodium Chloride18$168$9
Sulfamethoxazole-Trimethoprim22$116$5
Imipramine12$60$5

2017: 21 drugs

Part D drugs prescribed in 2017
Myrbetriq126$53,639$426
Elmiron19$26,920$1,417
Premarin45$15,883$353
Vesicare14$10,465$748
Estrace22$6,372$290
Tamsulosin232$5,855$25
Tolterodine Tartrate Er15$3,266$218
Trospium Chloride33$2,815$85
Oxybutynin Chloride Er65$2,793$43
Finasteride121$2,036$17
Methenamine Hippurate15$1,862$124
Monurol21$1,853$88
Methenamine Mandelate17$1,386$82
Cephalexin86$1,126$13
Amitriptyline28$766$27
Testosterone Cypionate11$388$35
Doxazosin Mesylate14$381$27
Sulfamethoxazole-Trimethoprim45$267$6
Nitrofurantoin Mono-Macro16$221$14
Ciprofloxacin25$116$5
Imipramine14$91$6

2016: 19 drugs

Part D drugs prescribed in 2016
Elmiron49$47,562$971
Myrbetriq117$42,786$366
Vesicare34$14,295$420
Premarin42$12,561$299
Tamsulosin217$5,459$25
Trospium Chloride Er14$3,530$252
Estrace13$3,500$269
Oxybutynin Chloride Er77$3,427$45
Tolterodine Tartrate Er12$3,104$259
Trospium Chloride28$2,413$86
Finasteride139$2,218$16
Amitriptyline25$1,007$40
Methenamine Hippurate15$954$64
Cephalexin85$818$10
Doxazosin Mesylate18$591$33
Nitrofurantoin Mono-Macro15$281$19
Sulfamethoxazole-Trimethoprim32$154$5
Imipramine19$135$7
Ciprofloxacin11$59$5

2015: 20 drugs

Part D drugs prescribed in 2015
Myrbetriq119$36,785$309
Elmiron33$31,349$950
Premarin83$21,539$260
Vesicare45$14,190$315
Tamsulosin166$5,209$31
Oxybutynin Chloride Er54$4,611$85
Toviaz17$4,265$251
Tolterodine Tartrate Er20$3,682$184
Vagifem15$3,334$222
Finasteride146$2,159$15
Nitrofurantoin29$1,195$41
Cephalexin98$1,112$11
Amitriptyline20$581$29
Doxazosin Mesylate12$411$34
Nitrofurantoin Mono-Macro14$301$21
Oxybutynin Chloride12$258$21
Sulfamethoxazole-Trimethoprim26$185$7
Ciprofloxacin27$143$5
Imipramine13$137$11
Levofloxacin11$38$3

2014: 18 drugs

Part D drugs prescribed in 2014
Elmiron25$20,555$822
Premarin81$18,116$224
Vesicare66$16,662$252
Myrbetriq48$13,979$291
Avodart27$7,567$280
Toviaz23$5,789$252
Trospium Chloride Er11$3,496$318
Tamsulosin145$3,054$21
Finasteride129$2,114$16
Nitrofurantoin29$1,268$44
Oxybutynin Chloride Er23$1,123$49
Cephalexin70$625$9
Nitrofurantoin Mono-Macro13$377$29
Alfuzosin Hcl Er14$365$26
Amitriptyline12$247$21
Oxybutynin Chloride16$222$14
Sulfamethoxazole-Trimethoprim33$199$6
Ciprofloxacin16$129$8

2013: 16 drugs

Part D drugs prescribed in 2013
Elmiron27$16,969$628
Vesicare65$16,413$253
Premarin46$8,603$187
Myrbetriq24$5,898$246
Toviaz17$3,787$223
Avodart19$3,599$189
Trospium Chloride Er13$2,955$227
Enablex15$2,680$179
Tamsulosin94$1,911$20
Oxybutynin Chloride Er32$1,863$58
Nitrofurantoin25$1,124$45
Finasteride30$948$32
Nitrofurantoin Mono-Macro24$672$28
Cephalexin47$412$9
Sulfamethoxazole-Trimethoprim30$201$7
Ciprofloxacin19$93$5

Money from drug and device companies

$109 in 2025

Industry payments by year
202544None$109
202411None$18
202357None$572
202233None$295

Paid work is consulting, speaking, honoraria and royalties, as opposed to meals and travel.

A payment is not proof that care is biased.

Payments by company
Janssen Scientific AffairsErleada$36
1 payment
  • Meals for Erleada · 2025-03-15 · $36
Astellas Pharma USPadcev$27
1 payment
  • Meals for Padcev · 2025-11-13 · $27
Bayer Healthcare PharmaceuticalsNubeqa$25
1 payment
  • Meals for Nubeqa · 2025-08-27 · $25
Tactile Systems TechnologyFlexitouch Plus$22
1 payment
  • Meals for Flexitouch Plus · 2025-03-07 · $22
See all 4 published payments
Every published payment
Astellas Pharma USMeals · 2025-11-13Padcev$27
Bayer Healthcare PharmaceuticalsMeals · 2025-08-27Nubeqa$25
Janssen Scientific AffairsMeals · 2025-03-15Erleada$36
Tactile Systems TechnologyMeals · 2025-03-07Flexitouch Plus$22
See earlier years (2024, 2023, 2022)

2024: $18

Payments by company in 2024
PfizerInlyta$18
1 payment
  • Education for Inlyta · 2024-09-19 · $18

2023: $572

Payments by company in 2023
Myriad Genetic LaboratoriesPrecisetumor$152
3 payments
  • Meals for Precisetumor · 2023-07-19 · $61
  • Meals for Prolaris · 2023-03-29 · $23
  • Meals for Precisetumor · 2023-03-02 · $68
Janssen PharmaceuticalsXarelto$128
1 payment
  • Meals for Xarelto · 2023-05-11 · $128
ItiCaplyta$126
1 payment
  • Meals for Caplyta · 2023-02-08 · $126
Exact SciencesCologuard Collection Kit$124
1 payment
  • Meals for Cologuard Collection Kit · 2023-10-11 · $124
Astellas Pharma USXtandi$43
1 payment
  • Meals for Xtandi · 2023-04-30 · $43

2022: $295

Payments by company in 2022
Neurocrine BiosciencesIngrezza$131
1 payment
  • Meals for Ingrezza · 2022-10-12 · $131
AmgenRepatha$125
1 payment
  • Meals for Repatha · 2022-08-10 · $125
Astellas Pharma USNone$40
1 payment
  • Meals · 2022-05-13 · $40

Checkups this office reported

Medicare did not publish checkup rates for this clinician.

Medicare’s overall office score
76.5 / 100
Scores the office’s reporting and systems. It is not a grade for how the doctor treats you.

Professional record

NPI
1689850745
Licence
CA 17970California C17970: Cancelled
Video visits
Lists video visits
Gender
Female
More record details
Sole proprietor
No
Taxonomy
Nurse practitioner (363L00000X); Federal specialty code 363LA2200X (363LA2200X); Federal specialty code 363LF0000X (363LF0000X); Federal specialty code 363LP2300X (363LP2300X)
Mailing address
300 Pasteur Dr, Stanford, CA, 94305
NPI first listed
2008-01-18
NPI last updated
2025-12-30
NPI record certified
2025-12-30

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