Douglas G Hetzler, MD
Otolaryngology · Santa Cruz
- Medicare standing
- Clear
- Enrolled, allowed to bill and order, not excluded
- Plans that list them
- 1
- 1 carrier
- Offices
- 4
- Since medical school
- 45 years
- University of Iowa, Rj & L Carver College of Medicine, 1981
Offices
4 locations · Sutter Bay Medical Foundation · 3,783 clinicians in this group
Hospitals listed: Dominican Hospital. 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 Dr. Hetzler’s office to confirm they take your plan. Ask about the office you use, its medical group, referrals and appointments.
| Alignment Health Sutter Advantage +More (HMO) | Alignment Health Plan | Listed | Oct 3, 2026 |
California Medical Board record
Licence C41078 · Current
Licensed to practise in California · since 1983 · expires 2028-11-30 · University of Iowa College of Medicine.
No disciplinary actions, convictions, malpractice judgments or citations in this record.
School, training and certification
What this clinician told their state board, medical school and everything before it. Only some states publish this, so nothing here means the state does not say, not that there was no training or certification.
Specialty certification
- American Board of Otolaryngology - Otolaryngology
Hospitals they work in
1 hospital
These rate the hospital, not this clinician. Most measures at most hospitals are no different from the national rate.
- Dominican HospitalSanta Cruz, 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 4 of 5 · 68% would definitely recommend itOverall rating: 4 of 5 starsWorse than the national rate — Postoperative sepsis rate: 11.66 (8.02 to 15.3) · 412 cases, Jul 2022 – Jun 2024Better than the national rate — Catheter Associated Urinary Tract Infections (ICU + select Wards): 0.168, Oct 2024 – Sep 2025Better than the national rate — Central Line Associated Bloodstream Infection (ICU + select Wards): 0.169, Oct 2024 – Sep 2025Better than the national rate — Clostridium Difficile (C.Diff): 0.489, Oct 2024 – Sep 2025
See every measure and the patient survey for Dominican Hospital
Behind the star rating — Deaths: 1 better, 7 the same, 0 worse of 8 measures. Safety: 2 better, 5 the same, 0 worse of 7 measures. Readmissions: 1 better, 8 the same, 2 worse of 11 measures. The star rating is worked out from an earlier period than the measures below, so the two can disagree.
| Postoperative sepsis rateComplications and deaths | 11.66 (8.02 to 15.3) · 412 cases | Worse | Jul 2022 – Jun 2024 |
| Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections | 0.168 | Better | Oct 2024 – Sep 2025 |
| Central Line Associated Bloodstream Infection (ICU + select Wards)Infections | 0.169 | Better | Oct 2024 – Sep 2025 |
| Clostridium Difficile (C.Diff)Infections | 0.489 | Better | Oct 2024 – Sep 2025 |
| Abdominopelvic accidental puncture or laceration rateComplications and deaths | 1.01 (0.06 to 1.95) · 1,248 cases | No different | Jul 2022 – Jun 2024 |
| CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths | 1.14 (0.85 to 1.43) | No different | Jul 2022 – Jun 2024 |
| Death rate among surgical inpatients with serious treatable complicationsComplications and deaths | 134.37 (94.33 to 174.41) · 132 cases | No different | Jul 2022 – Jun 2024 |
| Death rate for CABG surgery patientsComplications and deaths | 2.4 · 54 cases | None | Jul 2022 – Jun 2025 |
| Death rate for COPD patientsComplications and deaths | 7.2 · 137 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart attack patientsComplications and deaths | 12 · 228 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart failure patientsComplications and deaths | 10.5 · 534 cases | None | Jul 2022 – Jun 2025 |
| Death rate for pneumonia patientsComplications and deaths | 12.8 · 491 cases | None | Jul 2022 – Jun 2025 |
| Death rate for stroke patientsComplications and deaths | 8.7 · 278 cases | None | Jul 2023 – Jun 2025 |
| Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths | 3.4 · 2,973 cases | None | Jul 2024 – Jun 2025 |
| Iatrogenic pneumothorax rateComplications and deaths | 0.14 (0 to 0.34) · 7,510 cases | No different | Jul 2022 – Jun 2024 |
| In-hospital fall-associated fracture rateComplications and deaths | 0.21 (0.02 to 0.4) · 7,695 cases | No different | Jul 2022 – Jun 2024 |
| Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths | 3.42 (1.44 to 5.4) · 1,594 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative acute kidney injury requiring dialysis rateComplications and deaths | 1.26 (0 to 2.76) · 436 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative hemorrhage or hematoma rateComplications and deaths | 1.85 (0.4 to 3.29) · 1,474 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative respiratory failure rateComplications and deaths | 8.73 (3 to 14.46) · 437 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative wound dehiscence rateComplications and deaths | 1.58 (0.13 to 3.03) · 343 cases | No different | Jul 2022 – Jun 2024 |
| Pressure ulcer rateComplications and deaths | 0.57 (0 to 1.17) · 6,336 cases | No different | Jul 2022 – Jun 2024 |
| MRSA BacteremiaInfections | 0.615 | No different | Oct 2024 – Sep 2025 |
| SSI - Colon SurgeryInfections | 1.937 | No different | Oct 2024 – Sep 2025 |
| Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits | 16 · 212 cases | None | Jul 2023 – Jun 2025 |
| Heart failure (HF) 30-Day Readmission RateUnplanned return visits | 22 · 505 cases | None | Jul 2023 – Jun 2025 |
| Hospital return days for heart attack patientsUnplanned return visits | 45 · 237 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for heart failure patientsUnplanned return visits | -13.5 · 594 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for pneumonia patientsUnplanned return visits | 1.9 · 510 cases | None | Jul 2022 – Jun 2025 |
| Pneumonia (PN) 30-Day Readmission RateUnplanned return visits | 16.9 · 473 cases | None | Jul 2023 – Jun 2025 |
| Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits | 5.2 (3.4 to 7.8) · 126 cases | No different | Jan 2024 – Dec 2024 |
| Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits | 13 (9.4 to 17.7) · 126 cases | No different | Jan 2024 – Dec 2024 |
| Rate of readmission for CABGUnplanned return visits | 12.7 · 43 cases | None | Jul 2023 – Jun 2025 |
| Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits | 19.7 · 143 cases | None | Jul 2023 – Jun 2025 |
| Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits | 12.1 (9.4 to 15.4) · 1,585 cases | No different | Jan 2022 – Dec 2024 |
| Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits | 1 (0.7 to 1.3) · 390 cases | No different | Jan 2024 – Dec 2024 |
What patients said (774 patients answered, 23% of those asked)
| Cleanliness | 4 |
| Nurse communication | 4 |
| Doctor communication | 4 |
| Communication about medicines | 3 |
| Discharge information | 4 |
| Overall hospital rating | 3 |
| Quietness | 1 |
| Recommend hospital | 4 |
| Room was "always" clean | 73% |
| Nurses "always" communicated well | 79% |
| Doctors "always" communicated well | 81% |
| Staff "always" explained | 61% |
| Yes, staff "did" give patients this information | 87% |
| Yes, staff "did" give patients information about help after discharge | 86% |
| Doctors "always" explained things so they could understand | 77% |
| Doctors "always" listened carefully | 79% |
| Doctors "always" treated them with courtesy and respect | 87% |
| Patients who gave a rating of "9" or "10" (high) | 67% |
| Staff "always" explained new medications | 75% |
| Nurses "always" explained things so they could understand | 76% |
| Nurses "always" listened carefully | 76% |
| Nurses "always" treated them with courtesy and respect | 85% |
| "Always" quiet at night | 32% |
| "YES", patients would definitely recommend the hospital | 68% |
| Staff "always" explained possible side effects | 48% |
| Yes, staff "did" give patients information about possible symptoms | 88% |
Original Medicare doctor bills
$67,938
Medicare paid this office $67,938 for 296 people.
This is what Medicare paid the clinician — not Medicare Advantage, and not the pharmacy.
| Reconstruction of ear canal | 15 | $19,018 | $1,268 |
| Short return visit (20+ min) | 152 | $16,849 | $68 |
| New patient visit (30+ min) | 94 | $7,669 | $82 |
| Removal of impacted ear wax | 120 | $6,730 | $34 |
| Diagnostic exam of voice box using a flexible endoscope | 37 | $4,388 | $107 |
See all 8 services
| Reconstruction of ear canal | 15 | $19,018 | $1,268 |
| Short return visit (20+ min) | 152 | $16,849 | $68 |
| New patient visit (30+ min) | 94 | $7,669 | $82 |
| Removal of impacted ear wax | 120 | $6,730 | $34 |
| Diagnostic exam of voice box using a flexible endoscope | 37 | $4,388 | $107 |
| Diagnostic exam of nasal passages using an endoscope | 14 | $2,600 | $162 |
| Return visit (30+ min) | 21 | $2,015 | $88 |
| New patient visit (15+ min) | 16 | $878 | $55 |
Procedures year by year
| Procedure | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |
|---|---|---|---|---|---|---|
| Removal of impacted ear wax | 238 | 187 | 186 | 184 | 178 | 196 |
| Diagnostic exam of voice box using a flexible endoscope | 61 | 57 | 40 | 57 | 48 | 41 |
| Reconstruction of ear canal | 13 | 15 | 14 | 15 | 15 | 15 |
| Diagnostic exam of nasal passages using an endoscope | 14 | – | – | 15 | – | 16 |
Times billed to Original Medicare each year. A blank year means fewer than 11 people had it, or none: Medicare does not publish smaller counts. Medicare Advantage patients are not included.
Who their Medicare patients are
296 Original Medicare patients in 2024. Average age 75 · Under 65 5% · 85 and older 12% · Women 51% · Also on Medicaid 11% · Health risk score 0.89. At or below the middle of the specialty; the typical otolaryngology clinician is at 1.19.
Conditions among them: High blood pressure 58% · Coronary heart disease 17% · Diabetes 16% · Atrial fibrillation 16% · Depression 16% · Cancer 15% · Chronic kidney disease 13% · COPD 9% · Heart failure 8% · Stroke 6% · Dementia 4%.
The office billed $351,965, Medicare allowed $92,895 and paid $67,938; for 717 services of 40 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
| 2024 | 296 | 717 | 75 | 0.89 | $351,965 | $67,938 |
| 2023 | 293 | 708 | 76 | 0.88 | $326,370 | $69,855 |
| 2022 | 306 | 746 | 76 | 0.90 | $349,471 | $77,058 |
| 2021 | 299 | 659 | 75 | 0.94 | $272,446 | $65,000 |
| 2020 | 284 | 646 | 75 | 1.07 | $271,737 | $59,141 |
| 2019 | 372 | 867 | 75 | 1.01 | $332,436 | $71,579 |
| 2018 | 442 | 918 | 74 | 0.92 | $410,549 | $87,468 |
| 2017 | 477 | 1,038 | 74 | 1.08 | $373,579 | $82,154 |
| 2016 | 449 | 969 | 75 | 1.04 | $375,897 | $81,359 |
| 2015 | 412 | 929 | 74 | 1.08 | $349,837 | $78,630 |
| 2014 | 422 | 923 | 75 | 0.98 | $300,377 | $68,909 |
| 2013 | 351 | 723 | 75 | 1.13 | $239,341 | $54,869 |
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: 8 services
| Reconstruction of ear canal | 15 | $19,883 | $1,326 |
| Short return visit (20+ min) | 164 | $19,787 | $72 |
| Removal of impacted ear wax | 120 | $6,470 | $36 |
| Diagnostic exam of voice box using a flexible endoscope | 46 | $5,341 | $111 |
| New patient visit (30+ min) | 67 | $5,297 | $79 |
| Return visit (30+ min) | 15 | $1,692 | $106 |
| New patient visit (15+ min) | 30 | $1,565 | $52 |
| Short return visit | 12 | $521 | $37 |
2022: 9 services
| Reconstruction of ear canal | 15 | $21,353 | $1,424 |
| Short return visit (20+ min) | 151 | $19,198 | $75 |
| Removal of impacted ear wax | 122 | $6,727 | $37 |
| Diagnostic exam of voice box using a flexible endoscope | 51 | $6,099 | $107 |
| New patient visit (30+ min) | 66 | $6,071 | $92 |
| Return visit (30+ min) | 25 | $2,685 | $99 |
| Diagnostic exam of nasal passages using an endoscope | 15 | $2,604 | $174 |
| New patient visit (15+ min) | 40 | $1,971 | $49 |
| Short return visit | 16 | $818 | $48 |
2021: 9 services
| Reconstruction of ear canal | 14 | $18,653 | $1,332 |
| Short return visit (20+ min) | 138 | $15,718 | $73 |
| Removal of impacted ear wax | 125 | $6,434 | $35 |
| New patient visit (30+ min) | 55 | $5,040 | $92 |
| Diagnostic exam of voice box using a flexible endoscope | 33 | $4,474 | $112 |
| Return visit (30+ min) | 31 | $3,443 | $108 |
| New patient visit (15+ min) | 39 | $2,126 | $55 |
| Short return visit | 14 | $660 | $41 |
| Repositioning exercises of head for treatment of dizziness, each day | 11 | $517 | $34 |
2020: 8 services
| Reconstruction of ear canal | 15 | $19,142 | $1,276 |
| Short return visit (20+ min) | 139 | $10,732 | $57 |
| Removal of impacted ear wax | 116 | $6,781 | $36 |
| Diagnostic exam of voice box using a flexible endoscope | 41 | $6,081 | $107 |
| New patient visit (30+ min) | 46 | $3,540 | $77 |
| New patient visit (15+ min) | 35 | $2,139 | $61 |
| Return visit (30+ min) | 21 | $2,019 | $96 |
| Short return visit | 31 | $1,163 | $36 |
2019: 10 services
| Reconstruction of ear canal | 13 | $16,281 | $1,252 |
| Short return visit (20+ min) | 182 | $15,621 | $57 |
| Removal of impacted ear wax | 149 | $8,420 | $35 |
| Diagnostic exam of voice box using a flexible endoscope | 51 | $6,258 | $103 |
| New patient visit (30+ min) | 50 | $4,102 | $82 |
| New patient visit (15+ min) | 52 | $3,041 | $58 |
| Return visit (30+ min) | 25 | $2,846 | $92 |
| Diagnostic exam of nasal passages using an endoscope | 14 | $2,459 | $176 |
| Short return visit | 31 | $1,198 | $33 |
| Repositioning exercises of head for treatment of dizziness, each day | 12 | $497 | $36 |
2018: 9 services
| Reconstruction of ear canal | 20 | $23,547 | $1,177 |
| Short return visit (20+ min) | 203 | $15,234 | $56 |
| Removal of impacted ear wax | 139 | $6,753 | $35 |
| New patient visit (15+ min) | 88 | $4,892 | $56 |
| New patient visit (30+ min) | 52 | $4,305 | $83 |
| Diagnostic exam of voice box using a flexible endoscope | 43 | $4,177 | $93 |
| Return visit (30+ min) | 35 | $2,995 | $81 |
| Short return visit | 39 | $1,493 | $32 |
| Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing | 11 | $440 | $40 |
2017: 9 services
| Short return visit (20+ min) | 209 | $16,621 | $55 |
| Reconstruction of ear canal | 12 | $14,685 | $1,224 |
| Removal of impacted ear wax | 152 | $7,222 | $34 |
| New patient visit (15+ min) | 128 | $7,060 | $55 |
| New patient visit (30+ min) | 82 | $6,814 | $83 |
| Diagnostic exam of voice box using a flexible endoscope | 43 | $4,532 | $92 |
| Return visit (30+ min) | 31 | $2,542 | $77 |
| Short return visit | 57 | $2,148 | $31 |
| Repositioning exercises of head for treatment of dizziness, each day | 17 | $1,069 | $36 |
2016: 9 services
| Reconstruction of ear canal | 16 | $19,757 | $1,235 |
| Short return visit (20+ min) | 183 | $14,481 | $55 |
| New patient visit (15+ min) | 143 | $7,623 | $53 |
| Removal of impacted ear wax | 131 | $6,186 | $36 |
| New patient visit (30+ min) | 58 | $4,768 | $82 |
| Diagnostic exam of voice box using a flexible endoscope | 39 | $3,692 | $95 |
| Short return visit | 73 | $2,976 | $31 |
| Return visit (30+ min) | 16 | $1,231 | $77 |
| Repositioning exercises of head for treatment of dizziness, each day | 15 | $744 | $34 |
2015: 8 services
| Short return visit (20+ min) | 171 | $14,673 | $58 |
| Removal of impacted ear wax | 142 | $6,805 | $38 |
| New patient visit (15+ min) | 119 | $6,481 | $54 |
| New patient visit (30+ min) | 54 | $4,403 | $82 |
| Diagnostic exam of voice box using a flexible endoscope | 34 | $3,599 | $97 |
| Short return visit | 73 | $2,884 | $34 |
| Return visit (30+ min) | 22 | $2,326 | $93 |
| Repositioning exercises of head for treatment of dizziness, each day | 21 | $995 | $34 |
2014: 9 services
| Short return visit (20+ min) | 179 | $14,109 | $53 |
| New patient visit (15+ min) | 120 | $6,212 | $52 |
| Removal of impacted ear wax | 135 | $6,003 | $34 |
| New patient visit (30+ min) | 72 | $5,490 | $76 |
| Short return visit | 77 | $3,053 | $32 |
| Diagnostic exam of nasal passages using an endoscope | 16 | $2,776 | $173 |
| Diagnostic exam of voice box using a flexible endoscope | 26 | $2,682 | $92 |
| Return visit (30+ min) | 22 | $1,957 | $78 |
| Repositioning exercises of head for treatment of dizziness, each day | 15 | $780 | $30 |
2013: 8 services
| Short return visit (20+ min) | 146 | $10,532 | $53 |
| New patient visit (15+ min) | 103 | $5,425 | $53 |
| Removal of impacted ear wax | 85 | $4,180 | $37 |
| Diagnostic exam of voice box using a flexible endoscope | 35 | $3,554 | $91 |
| New patient visit (30+ min) | 39 | $3,149 | $81 |
| Short return visit | 65 | $2,669 | $32 |
| Diagnostic exam of nasal passages using an endoscope | 12 | $2,081 | $173 |
| Return visit (30+ min) | 16 | $1,438 | $85 |
Drugs they prescribed that Part D paid
$3,764
Pharmacies billed $3,764 in 2024.
This is pharmacy cost, not the office bill, and not what patients paid.
126 generic and fewer than 11 brand-name prescriptions · $3,764 in drug cost · 15 antibiotic prescriptions.
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.
| Ipratropium | 18 | $620 | $34 |
| Neomycin-Polymyxin-Hydrocort | 13 | $516 | $40 |
| Prednisone | 19 | $79 | $4 |
Year by year
| 2024 | 135 | 64 | None | None | $3,764 |
| 2023 | 135 | 68 | None | 0% | $4,032 |
| 2022 | 122 | 54 | None | None | $4,755 |
| 2021 | 130 | 72 | None | None | $5,168 |
| 2020 | 128 | 60 | None | None | $4,558 |
| 2019 | 132 | 63 | None | None | $4,471 |
| 2018 | 182 | 83 | None | 10% | $8,433 |
| 2017 | 179 | 77 | None | 9% | $6,571 |
| 2016 | 145 | 66 | 13% (19) | 10% | $5,023 |
| 2015 | 125 | 68 | None | 11% | $4,920 |
| 2014 | 163 | 77 | 7% (12) | 10% | $5,695 |
| 2013 | 143 | 58 | 10% (14) | 11% | $5,528 |
Part D prescriptions only. A drug prescribed to fewer than 11 people in a year is hidden.
See the drugs prescribed each year
2023: 4 drugs
| Ipratropium | 28 | $1,566 | $56 |
| Neomycin-Polymyxin-Hydrocort | 12 | $702 | $59 |
| Fluticasone Propionate | 14 | $247 | $18 |
| Prednisone | 19 | $71 | $4 |
2022: 4 drugs
| Ipratropium | 14 | $1,154 | $82 |
| Fluticasone Propionate | 27 | $536 | $20 |
| Mupirocin | 11 | $58 | $5 |
| Prednisone | 14 | $38 | $3 |
2021: 4 drugs
| Ipratropium | 20 | $1,178 | $59 |
| Neomycin-Polymyxin-Hydrocort | 12 | $636 | $53 |
| Fluticasone Propionate | 24 | $473 | $20 |
| Prednisone | 12 | $29 | $2 |
2020: 3 drugs
| Ipratropium | 14 | $782 | $56 |
| Fluticasone Propionate | 27 | $590 | $22 |
| Prednisone | 15 | $76 | $5 |
2019: 2 drugs
| Fluticasone Propionate | 29 | $413 | $14 |
| Prednisone | 22 | $69 | $3 |
2018: 5 drugs
| Ipratropium | 25 | $1,939 | $78 |
| Neomycin-Polymyxin-Hydrocort | 21 | $1,189 | $57 |
| Fluticasone Propionate | 45 | $626 | $14 |
| Ciprofloxacin | 15 | $207 | $14 |
| Prednisone | 15 | $69 | $5 |
2017: 4 drugs
| Ipratropium | 28 | $1,604 | $57 |
| Neomycin-Polymyxin-Hydrocort | 19 | $863 | $45 |
| Fluticasone Propionate | 35 | $707 | $20 |
| Prednisone | 15 | $61 | $4 |
2016: 4 drugs
| Ipratropium | 20 | $986 | $49 |
| Fluticasone Propionate | 24 | $294 | $12 |
| Hydrocodone-Acetaminophen | 15 | $115 | $8 |
| Prednisone | 16 | $68 | $4 |
2015: 3 drugs
| Ipratropium | 21 | $806 | $38 |
| Fluticasone Propionate | 23 | $371 | $16 |
| Prednisone | 18 | $63 | $4 |
2014: 3 drugs
| Ipratropium | 33 | $1,079 | $33 |
| Fluticasone Propionate | 28 | $560 | $20 |
| Prednisone | 23 | $101 | $4 |
2013: 3 drugs
| Fluticasone Propionate | 32 | $1,012 | $32 |
| Ipratropium | 32 | $1,003 | $31 |
| Hydrocodone-Acetaminophen | 13 | $155 | $12 |
Professional record
- NPI
- 1801876701
- Licence
- CA C41078California C41078: Current · expires 2028-11-30
- Trained
- University of Iowa, Rj & L Carver College of Medicine, 1981 · 45 years ago
- Gender
- Male
More record details
- Sole proprietor
- No
- Taxonomy
- Otolaryngology (207Y00000X)
- Mailing address
- Po Box 1833, Santa Cruz, CA, 95061
- NPI first listed
- 2006-01-18
- NPI last updated
- 2026-07-13
This is when the NPI record was last certified, not a medical board exam.