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Julie A Letsinger, MD

Dermatology · Palo Alto

NPI 1871541565

Medicare standing
Clear
Enrolled, allowed to bill and order, not excluded
Plans that list them
1
1 carrier
Offices
2

Offices

2 locations · Sutter Bay Medical Foundation · 3,783 clinicians in this group

Looking this up.

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. Letsinger’s office 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 Sutter Advantage +More (HMO)Alignment Health PlanListedOct 3, 2026

California Medical Board record

Licence A74577 · Current

Licensed to practise in California · since 2001 · expires 2027-03-31 · University of California, Davis School of Medicine.

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

Original Medicare doctor bills

$151,805

Medicare paid this office $151,805 for 406 people.

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

Largest Original Medicare bills
Return visit (30+ min)253$46,197$112
Short return visit (20+ min)242$27,266$80
Destruction of precancer skin growth, 1 growth247$21,175$53
Destruction of skin growth, 1-14 growths93$14,946$113
Biopsy of related skin growth, first growth123$14,459$94
See all 12 services
Every Original Medicare service billed
Return visit (30+ min)253$46,197$112
Short return visit (20+ min)242$27,266$80
Destruction of precancer skin growth, 1 growth247$21,175$53
Destruction of skin growth, 1-14 growths93$14,946$113
Biopsy of related skin growth, first growth123$14,459$94
Destruction of precancer skin growth, 2-14 growths184$7,912$7
Punch biopsy, first skin growth27$3,680$131
Short return visit54$2,912$50
Long return visit (40+ min)12$2,843$167
Biopsy of related skin growth, each additional growth34$2,247$52
New patient visit (30+ min)11$1,094$99
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's13$300$15

Procedures Medicare counted

Procedure volume Medicare published
Removal of skin lesions723More than 90% of doctors who do this
Removal or shaving of skin growth1-10None
Skin biopsy142More than 80% of doctors who do this

Who their Medicare patients are

406 Original Medicare patients in 2024. Average age 77 · Women 63% · Health risk score 0.92. At or below the middle of the specialty; the typical dermatology clinician is at 1.01.

Conditions among them: High blood pressure 56% · Coronary heart disease 22% · Cancer 18% · Atrial fibrillation 18% · Chronic kidney disease 15% · Depression 13% · Diabetes 9% · Heart failure 7% · COPD 7% · Stroke 5% · Dementia 4%.

The office billed $524,120, Medicare allowed $205,248 and paid $151,805; for 2,827 services of 25 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
20244062,827770.92$524,120$151,805
20233842,874770.78$538,287$160,125
20223692,839770.78$561,055$164,884
20213692,824770.84$490,509$153,542
20203532,350770.90$381,637$109,943
20194422,824760.87$477,376$135,168
20184022,967760.87$437,500$124,154
20173612,904760.85$433,041$124,343
20163512,267750.84$354,926$99,371
20152891,710740.79$267,512$81,096
20142721,619740.83$232,901$70,428
20132261,153750.86$196,912$57,322

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: 11 services

Original Medicare services billed in 2023
Return visit (30+ min)267$51,375$109
Short return visit (20+ min)218$22,314$74
Destruction of precancer skin growth, 1 growth223$18,998$50
Destruction of skin growth, 1-14 growths118$18,145$116
Biopsy of related skin growth, first growth128$15,011$93
Destruction of precancer skin growth, 2-14 growths181$7,532$7
Punch biopsy, first skin growth31$5,277$132
Long return visit (40+ min)21$4,010$174
Destruction of precancer skin growth, 15 or more growths13$3,505$175
Biopsy of related skin growth, each additional growth47$3,372$52
Short return visit49$2,671$49

2022: 12 services

Original Medicare services billed in 2022
Return visit (30+ min)245$48,590$108
Short return visit (20+ min)211$23,466$75
Destruction of precancer skin growth, 1 growth218$18,530$51
Destruction of skin growth, 1-14 growths96$14,567$110
Biopsy of related skin growth, first growth125$14,356$91
Destruction of precancer skin growth, 2-14 growths169$7,696$7
Punch biopsy, first skin growth28$4,398$133
Biopsy of related skin growth, each additional growth40$3,397$52
Destruction of precancer skin growth, 15 or more growths14$3,387$161
Long return visit (40+ min)16$2,920$162
Short return visit45$2,206$43
New patient visit (30+ min)12$757$63

2021: 10 services

Original Medicare services billed in 2021
Return visit (30+ min)258$50,974$111
Short return visit (20+ min)211$22,212$79
Destruction of precancer skin growth, 1 growth216$19,748$53
Biopsy of related skin growth, first growth107$12,923$103
Destruction of skin growth, 1-14 growths90$12,620$117
Destruction of precancer skin growth, 2-14 growths167$8,089$7
Punch biopsy, first skin growth31$4,639$133
Long return visit (40+ min)22$4,389$169
Biopsy of related skin growth, each additional growth33$2,462$55
Short return visit28$1,472$51

2020: 10 services

Original Medicare services billed in 2020
Return visit (30+ min)249$32,903$91
Destruction of precancer skin growth, 1 growth211$16,050$50
Short return visit (20+ min)171$14,970$63
Destruction of skin growth, 1-14 growths94$12,544$114
Biopsy of related skin growth, first growth90$10,087$93
Destruction of precancer skin growth, 2-14 growths173$6,533$6
Punch biopsy, first skin growth23$3,108$130
Destruction of precancer skin growth, 15 or more growths13$2,914$162
Biopsy of related skin growth, each additional growth22$1,845$56
Short return visit34$1,361$35

2019: 13 services

Original Medicare services billed in 2019
Return visit (30+ min)258$36,240$92
Short return visit (20+ min)226$21,418$64
Destruction of precancer skin growth, 1 growth234$17,572$48
Biopsy of related skin growth, first growth139$15,658$91
Destruction of skin growth, 1-14 growths98$13,437$106
Destruction of precancer skin growth, 2-14 growths192$6,441$6
Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)15$5,001None
Destruction of precancer skin growth, 15 or more growths17$3,801$152
Short return visit68$2,966$38
Punch biopsy, first skin growth19$2,602$118
Application of light to destroy precancer skin growth15$2,102$131
Biopsy of related skin growth, each additional growth30$2,017$55
New patient visit (30+ min)11$757$69

2018: 11 services

Original Medicare services billed in 2018
Return visit (30+ min)230$32,968$91
Short return visit (20+ min)242$20,575$59
Destruction of precancer skin growth, 1 growth222$17,703$50
Destruction of skin growth, 1-14 growths103$14,712$107
Biopsy of single growth of skin and/or tissue113$12,106$90
Destruction of precancer skin growth, 2-14 growths169$5,631$5
Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)12$4,758None
Destruction of precancer skin growth, 15 or more growths15$3,211$140
Short return visit51$2,006$35
Application of light to destroy precancer skin growth12$1,703$122
Biopsy of each additional growth of skin and/or tissue25$870$30

2017: 9 services

Original Medicare services billed in 2017
Return visit (30+ min)230$30,582$85
Short return visit (20+ min)232$22,096$62
Destruction of precancer skin growth, 1 growth206$16,839$49
Destruction of skin growth, 1-14 growths94$14,737$106
Biopsy of single growth of skin and/or tissue114$13,166$89
Destruction of precancer skin growth, 2-14 growths160$5,913$5
Destruction of precancer skin growth, 15 or more growths22$5,372$141
Biopsy of each additional growth of skin and/or tissue30$1,289$31
Short return visit33$1,221$36

2016: 11 services

Original Medicare services billed in 2016
Return visit (30+ min)199$24,153$86
Short return visit (20+ min)205$17,705$61
Biopsy of single growth of skin and/or tissue123$13,102$89
Destruction of precancer skin growth, 1 growth193$12,792$48
Destruction of skin growth, 1-14 growths76$10,771$103
Destruction of precancer skin growth, 2-14 growths153$4,788$5
Destruction of precancer skin growth, 15 or more growths22$3,993$143
New patient visit (30+ min)21$1,912$91
Biopsy of each additional growth of skin and/or tissue37$1,380$30
Short return visit30$1,345$37
New patient visit (15+ min)11$691$63

2015: 10 services

Original Medicare services billed in 2015
Return visit (30+ min)140$19,582$99
Short return visit (20+ min)174$16,902$62
Destruction of precancer skin growth, 1 growth140$11,017$52
Biopsy of single growth of skin and/or tissue91$10,584$99
Destruction of skin growth, 1-14 growths56$8,548$114
Destruction of precancer skin growth, 2-14 growths103$3,672$6
New patient visit (30+ min)19$1,577$83
Short return visit38$1,407$36
Biopsy of each additional growth of skin and/or tissue27$960$32
New patient visit (15+ min)11$818$74

2014: 11 services

Original Medicare services billed in 2014
Short return visit (20+ min)192$17,783$58
Destruction of precancer skin growth, 1 growth124$10,736$57
Biopsy of single growth of skin and/or tissue83$9,317$90
Return visit (30+ min)53$7,819$93
Destruction of precancer skin growth, 2-14 growths96$5,962$10
Destruction of skin growth, 1-14 growths50$5,882$98
Short return visit62$2,641$36
Application of ultraviolet light to skin13$2,273$20
New patient visit (30+ min)20$1,828$91
New patient visit (15+ min)14$916$65
Biopsy of each additional growth of skin and/or tissue24$812$30

2013: 11 services

Original Medicare services billed in 2013
Short return visit (20+ min)154$13,854$59
Biopsy of single growth of skin and/or tissue78$9,013$98
Destruction of precancer skin growth, 1 growth108$9,009$62
Return visit (30+ min)51$8,237$96
Destruction of skin growth, 1-14 growths33$4,731$110
Destruction of precancer skin growth, 15 or more growths11$2,415$161
Destruction of precancer skin growth, 2-14 growths81$2,359$6
Short return visit43$2,180$40
New patient visit (30+ min)20$1,256$63
New patient visit (15+ min)14$796$57
Biopsy of each additional growth of skin and/or tissue20$730$30

Drugs they prescribed that Part D paid

$480,235

Pharmacies billed $480,235 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 631) in 2024. At or below the middle of the specialty; the typical dermatology clinician is at 0%.

566 generic and 65 brand-name prescriptions · $480,235 in drug cost · 15 antibiotic prescriptions to 13 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
Skyrizi12$248,336$20,695
Dupixent22$114,558$5,207
Ciclopirox67$1,800$27
Clobetasol Propionate26$1,476$57
Fluorouracil18$1,436$80
See all 17 drugs
Every Part D drug this clinician prescribed
Skyrizi12$248,336$20,695
Dupixent22$114,558$5,207
Ciclopirox67$1,800$27
Clobetasol Propionate26$1,476$57
Fluorouracil18$1,436$80
Fluocinonide32$1,263$39
Triamcinolone Acetonide65$787$12
Ketoconazole44$781$18
Alclometasone Dipropionate16$764$48
Ciclopirox26$560$22
Doxycycline Hyclate18$402$22
Mometasone Furoate18$291$16
Mupirocin31$276$9
Minoxidil16$237$15
Econazole Nitrate12$204$17
Valacyclovir18$170$9
Hydrocortisone12$87$7

Year by year

Part D prescribing by year
20246312250% (0)10%$480,235
20235982150% (0)9%$406,832
20225352110% (0)5%$135,236
20215642050% (0)6%$84,902
20205151840% (0)8%$73,599
20195281980% (0)7%$78,480
20184381870% (0)16%$118,134
2017493202None10%$67,127
20164101500% (0)None$35,255
20153161300% (0)17%$36,774
20142721190% (0)None$26,274
2013325115NoneNone$23,523

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

See the drugs prescribed each year

2023: 18 drugs

Part D drugs prescribed in 2023
Skyrizi12$241,072$20,089
Dupixent11$48,073$4,370
Calcipotriene12$3,265$272
Fluorouracil35$2,626$75
Tacrolimus12$1,992$166
Clobetasol Propionate31$1,902$61
Ciclopirox42$1,318$31
Azelaic Acid14$1,184$85
Fluocinonide25$1,129$45
Triamcinolone Acetonide62$766$12
Alclometasone Dipropionate16$706$44
Doxycycline Hyclate21$685$33
Ketoconazole30$645$22
Mometasone Furoate27$545$20
Ciclopirox19$483$25
Mupirocin35$382$11
Clindamycin Phosphate17$370$22
Minoxidil22$177$8

2022: 13 drugs

Part D drugs prescribed in 2022
Fluorouracil36$3,259$91
Calcipotriene17$2,544$150
Fluocinonide36$2,030$56
Ciclopirox47$1,820$39
Clobetasol Propionate32$1,790$56
Alclometasone Dipropionate12$692$58
Mometasone Furoate28$685$24
Clindamycin Phosphate18$614$34
Triamcinolone Acetonide51$606$12
Ketoconazole21$466$22
Valacyclovir15$343$23
Ciclopirox15$317$21
Mupirocin33$314$10

2021: 17 drugs

Part D drugs prescribed in 2021
Metronidazole24$3,255$136
Clobetasol Propionate36$2,894$80
Fluorouracil32$2,601$81
Fluocinonide39$2,090$54
Ciclopirox38$1,857$49
Calcipotriene12$1,544$129
Fluocinolone Acetonide13$1,327$102
Alclometasone Dipropionate16$1,002$63
Ciclopirox19$985$52
Clindamycin Phosphate28$834$30
Ketoconazole38$785$21
Mometasone Furoate32$724$23
Econazole Nitrate16$555$35
Triamcinolone Acetonide41$484$12
Valacyclovir15$280$19
Betamethasone Diprop Augmented13$274$21
Mupirocin22$158$7

2020: 15 drugs

Part D drugs prescribed in 2020
Fluorouracil27$3,720$138
Metronidazole17$3,030$178
Calcipotriene16$2,436$152
Ciclopirox47$2,286$49
Fluocinonide33$2,236$68
Clobetasol Propionate31$2,112$68
Alclometasone Dipropionate21$1,120$53
Econazole Nitrate17$833$49
Mometasone Furoate34$677$20
Ketoconazole37$647$17
Triamcinolone Acetonide45$600$13
Mupirocin25$240$10
Valacyclovir14$196$14
Gabapentin13$130$10
Hydrocortisone14$103$7

2019: 15 drugs

Part D drugs prescribed in 2019
Clobetasol Propionate32$4,975$155
Calcipotriene16$3,008$188
Fluocinonide39$2,609$67
Fluorouracil20$2,052$103
Ciclopirox42$2,006$48
Ketoconazole44$1,078$25
Econazole Nitrate15$958$64
Alclometasone Dipropionate18$933$52
Triamcinolone Acetonide60$652$11
Mometasone Furoate22$646$29
Clindamycin Phosphate14$566$40
Nystatin12$298$25
Valacyclovir19$259$14
Mupirocin12$148$12
Hydrocortisone18$118$7

2018: 11 drugs

Part D drugs prescribed in 2018
Humira13$64,192$4,938
Clobetasol Propionate22$2,651$121
Ciclopirox44$2,394$54
Fluorouracil16$1,747$109
Fluocinonide29$1,747$60
Triamcinolone Acetonide61$896$15
Clindamycin Phosphate19$857$45
Alclometasone Dipropionate11$793$72
Betamethasone Diprop Augmented12$720$60
Mometasone Furoate23$586$25
Ketoconazole30$456$15

2017: 13 drugs

Part D drugs prescribed in 2017
Clobetasol Propionate48$6,812$142
Metronidazole15$3,308$221
Fluocinonide40$3,001$75
Alclometasone Dipropionate19$1,569$83
Fluorouracil11$1,393$127
Ciclopirox34$1,360$40
Betamethasone Dipropionate14$1,335$95
Triamcinolone Acetonide67$956$14
Clindamycin Phosphate14$707$51
Mometasone Furoate28$589$21
Ketoconazole19$401$21
Prednisone24$178$7
Gabapentin12$73$6

2016: 9 drugs

Part D drugs prescribed in 2016
Clobetasol Propionate49$7,775$159
Fluocinonide56$3,764$67
Ciclopirox33$1,582$48
Fluorouracil11$1,162$106
Triamcinolone Acetonide48$986$21
Clindamycin Phosphate12$631$53
Mometasone Furoate13$368$28
Mupirocin20$299$15
Gabapentin13$236$18

2015: 7 drugs

Part D drugs prescribed in 2015
Clobetasol Propionate43$14,259$332
Fluocinonide16$1,526$95
Ciclopirox24$1,161$48
Triamcinolone Acetonide39$664$17
Gabapentin19$473$25
Hydroxychloroquine Sulfate12$442$37
Mupirocin12$135$11

2014: 8 drugs

Part D drugs prescribed in 2014
Clobetasol Propionate28$3,596$128
Desonide12$2,365$197
Fluocinonide26$1,558$60
Tretinoin11$1,142$104
Ciclopirox16$708$44
Triamcinolone Acetonide28$675$24
Nystatin18$636$35
Mupirocin16$157$10

2013: 9 drugs

Part D drugs prescribed in 2013
Desonide24$3,373$141
Clobetasol Propionate28$1,625$58
Fluocinonide35$1,350$39
Nystatin30$1,083$36
Triamcinolone Acetonide32$993$31
Ciclopirox13$681$52
Mupirocin20$331$17
Cephalexin11$123$11
Prednisone12$76$6

Money from drug and device companies

$705 in 2025

Industry payments by year
2025823None$705
2024910None$394
202322None$35
202044None$79
201945None$93

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
Regeneron Healthcare SolutionsDupixent$233
6 payments
  • Meals for Dupixent · 2025-12-04 · $17
  • Education for Dupixent · 2025-12-04 · $81
  • Meals for Dupixent · 2025-10-14 · $14
  • Meals for Dupixent · 2025-09-23 · $18
  • Meals for Dupixent · 2025-04-29 · $18
  • Education for Dupixent · 2025-01-31 · $85
Sun Pharmaceutical IndustriesIlumya$146
3 payments
  • Meals for Winlevi · 2025-11-17 · $14
  • Education · 2025-11-13 · $100
  • Meals for Ilumya · 2025-10-21 · $32
Arcutis BiotherapeuticsZoryve$87
4 payments
  • Meals for Zoryve · 2025-05-29 · $18
  • Meals for Zoryve · 2025-05-09 · $16
  • Meals for Zoryve · 2025-03-25 · $26
  • Meals for Zoryve · 2025-01-24 · $27
OrganonVtama$64
3 payments
  • Meals for Vtama · 2025-12-05 · $9
  • Meals for Vtama · 2025-09-16 · $26
  • Meals for Vtama · 2025-01-28 · $29
IncyteOpzelura$61
2 payments
  • Meals for Opzelura · 2025-10-28 · $39
  • Meals for Opzelura · 2025-10-08 · $22
Lilly USAEbglyss$54
2 payments
  • Meals for Taltz · 2025-09-30 · $27
  • Meals for Ebglyss · 2025-08-05 · $27
See all 23 published payments
Every published payment
AmgenMeals · 2025-12-10Otezla$22
OrganonMeals · 2025-12-05Vtama$9
Regeneron Healthcare SolutionsMeals · 2025-12-04Dupixent$17
Regeneron Healthcare SolutionsEducation · 2025-12-04Dupixent$81
AmgenMeals · 2025-11-21Otezla$20
Sun Pharmaceutical IndustriesMeals · 2025-11-17Winlevi$14
Sun Pharmaceutical IndustriesEducation · 2025-11-13None$100
IncyteMeals · 2025-10-28Opzelura$39
Sun Pharmaceutical IndustriesMeals · 2025-10-21Ilumya$32
Regeneron Healthcare SolutionsMeals · 2025-10-14Dupixent$14
IncyteMeals · 2025-10-08Opzelura$22
Lilly USAMeals · 2025-09-30Taltz$27
Regeneron Healthcare SolutionsMeals · 2025-09-23Dupixent$18
OrganonMeals · 2025-09-16Vtama$26
Galderma Laboratories L.P.Meals · 2025-08-21Nemluvio$19
Lilly USAMeals · 2025-08-05Ebglyss$27
Arcutis BiotherapeuticsMeals · 2025-05-29Zoryve$18
Arcutis BiotherapeuticsMeals · 2025-05-09Zoryve$16
Regeneron Healthcare SolutionsMeals · 2025-04-29Dupixent$18
Arcutis BiotherapeuticsMeals · 2025-03-25Zoryve$26
Regeneron Healthcare SolutionsEducation · 2025-01-31Dupixent$85
OrganonMeals · 2025-01-28Vtama$29
Arcutis BiotherapeuticsMeals · 2025-01-24Zoryve$27
See earlier years (2024, 2023, 2020, 2019)

2024: $394

Payments by company in 2024
UcbBimzelx$167
1 payment
  • Meals for Bimzelx · 2024-01-08 · $167
IncyteOpzelura$47
2 payments
  • Meals for Opzelura · 2024-10-01 · $25
  • Meals for Opzelura · 2024-04-30 · $22
AbbvieSkyrizi$35
1 payment
  • Meals for Skyrizi · 2024-05-29 · $35
AmgenOtezla$31
1 payment
  • Meals for Otezla · 2024-10-18 · $31
Galderma Laboratories L.P.None$28
1 payment
  • Meals · 2024-10-22 · $28
Novartis PharmaceuticalsCosentyx$28
1 payment
  • Meals for Cosentyx · 2024-07-30 · $28
Ortho Dermatologics a division of Bausch Health USCabtreo$21
1 payment
  • Meals for Cabtreo · 2024-05-30 · $21
PfizerEucrisa$20
1 payment
  • Meals for Eucrisa · 2024-08-27 · $20
Regeneron Healthcare SolutionsDupixent$19
1 payment
  • Meals for Dupixent · 2024-11-19 · $19

2023: $35

Payments by company in 2023
Lilly USANone$19
1 payment
  • Meals · 2023-10-12 · $19
PfizerCibinqo$15
1 payment
  • Education for Cibinqo · 2023-04-10 · $15

2020: $79

Payments by company in 2020
AbbVieSkyrizi$22
1 payment
  • Meals for Skyrizi · 2020-12-01 · $22
Regeneron Healthcare SolutionsDupixent$21
1 payment
  • Meals for Dupixent · 2020-02-24 · $21
Novartis PharmaceuticalsCosentyx$20
1 payment
  • Meals for Cosentyx · 2020-01-21 · $20
Sun Pharmaceutical IndustriesIlumya$15
1 payment
  • Meals for Ilumya · 2020-02-04 · $15

2019: $93

Payments by company in 2019
Regeneron Healthcare SolutionsDupixent$33
2 payments
  • Meals for Dupixent · 2019-05-08 · $19
  • Meals for Dupixent · 2019-02-06 · $15
Sun Pharmaceutical IndustriesIlumya$23
1 payment
  • Meals for Ilumya · 2019-04-23 · $23
AbbVieHumira$19
1 payment
  • Meals for Humira · 2019-01-15 · $19
Lilly USATaltz$18
1 payment
  • Meals for Taltz · 2019-12-04 · $18

Professional record

NPI
1871541565
Licence
CA A74577California A74577: Current · expires 2027-03-31
Trained
University of California, Davis School of Medicine, 1999
Gender
Female
More record details
Sole proprietor
No
Taxonomy
Federal specialty code 207N00000X (207N00000X)
Mailing address
2350 W. El Camino Real, 2nd Floor, Mountain View, CA, 94040
NPI first listed
2006-05-04
NPI last updated
2011-11-10

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