ARUNA AKUNDI MD
Prescription History 1265488233
Emergency Medicine in Kaufman, TX

NPI Status: Active since May 25, 2006

Contact Information

850 W HIGHWAY 243
KAUFMAN, TX
ZIP 75142
Phone: (972) 932-7200

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Prescription History for Informed Healthcare Decisions

Explore the verified Medicare Part D prescription history, volume metrics, and calculated drug costs for ARUNA AKUNDI MD, an active Emergency Medicine specialist practicing in Kaufman, TX. Our medical registry currently tracks 17 unique pharmaceutical formulations prescribed by this provider, representing an estimated volume of 425 documented patient claims. Among these therapy options, the most frequently utilized medication is Methylprednisolone, which accounts for 73 claims alone.


Acetaminophen-Codeine

Generic Formulation: Acetaminophen With CodeineSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 38
30-Day Fills 38.0
Days Supply 188
TX State Average Benchmarks
Peer Average Claims44.0
Peer Average 30-Day Fills44.7
Peer Average Days Supply736
Standard Average Utilization

This provider's prescribing patterns for this therapeutic formulation sit directly in line with standard baseline averages across TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $194.10 across this reporting matrix range.

Provider Avg Cost Per Claim

$5.11

State Avg Cost Per Claim

$18.55

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Therapeutic Applications

See also Warning section. This combination medication is used to help relieve mild to moderate pain. It contains an opioid pain reliever (codeine) and a non-opioid pain reliever (acetaminophen). Codeine works in the brain to change how your body feels and responds to pain. Acetaminophen can also reduce a fever.

Albuterol Sulfate Hfa

Generic Formulation: Albuterol SulfateSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 17
30-Day Fills 17.0
Days Supply 356
TX State Average Benchmarks
Peer Average Claims51.0
Peer Average 30-Day Fills65.6
Peer Average Days Supply1,666
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 66.7% less volume than the regional standard for practitioners inside TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $596.24 across this reporting matrix range.

Provider Avg Cost Per Claim

$35.07

State Avg Cost Per Claim

$49.62

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Clinical Summary

A short-acting beta-2 adrenergic agonist that is primarily used as a bronchodilator agent to treat ASTHMA. Albuterol is prepared as a racemic mixture of R(-) and S(+) stereoisomers. The stereospecific preparation of R(-) isomer of albuterol is referred to as levalbuterol.

Therapeutic Applications

Albuterol (also known as salbutamol) is used to treat wheezing and shortness of breath caused by breathing problems such as asthma. It is a quick-relief medication. Albuterol belongs to a class of drugs known as bronchodilators. It works by relaxing the muscles around the airways so that they open up and you can breathe more easily. Controlling symptoms of breathing problems can decrease time lost from work or school.

Cefdinir

Generic Formulation: CefdinirSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 17
30-Day Fills 17.0
Days Supply 140
TX State Average Benchmarks
Peer Average Claims29.0
Peer Average 30-Day Fills29.4
Peer Average Days Supply254
Conservative Utilization

This provider writes prescriptions for this formulation 41.4% less frequently than the standard regional baseline metric for practitioners inside TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $465.58 across this reporting matrix range.

Provider Avg Cost Per Claim

$27.39

State Avg Cost Per Claim

$20.42

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Clinical Summary

A third-generation oral cephalosporin antibacterial agent that is used to treat bacterial infections of the respiratory tract and skin.

Therapeutic Applications

Cefdinir is used to treat a wide variety of bacterial infections. This medication is known as a cephalosporin antibiotic. It works by stopping the growth of bacteria. This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

Ciprofloxacin Hcl

Generic Formulation: Ciprofloxacin HclSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 11
30-Day Fills 11.0
Days Supply 99
TX State Average Benchmarks
Peer Average Claims31.0
Peer Average 30-Day Fills31.7
Peer Average Days Supply288
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 64.5% less volume than the regional standard for practitioners inside TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $88.59 across this reporting matrix range.

Provider Avg Cost Per Claim

$8.05

State Avg Cost Per Claim

$8.13

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Clinical Summary

A broad-spectrum antimicrobial carboxyfluoroquinoline.

Therapeutic Applications

This medication is used to treat eye infections. Ciprofloxacin belongs to a class of drugs called quinolone antibiotics. It works by stopping the growth of bacteria. This medication treats only bacterial eye infections. It will not work for other types of eye infections. Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness.

Dicyclomine Hcl

Generic Formulation: Dicyclomine HclSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 13
30-Day Fills 13.0
Days Supply 65
TX State Average Benchmarks
Peer Average Claims28.0
Peer Average 30-Day Fills38.8
Peer Average Days Supply970
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 53.6% less volume than the regional standard for practitioners inside TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $62.24 across this reporting matrix range.

Provider Avg Cost Per Claim

$4.79

State Avg Cost Per Claim

$21.73

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Doxycycline Hyclate

Generic Formulation: Doxycycline HyclateSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 45
30-Day Fills 45.0
Days Supply 351
TX State Average Benchmarks
Peer Average Claims31.0
Peer Average 30-Day Fills33.7
Peer Average Days Supply495
Elevated Utilization

This provider maintains an active emphasis on this therapeutic option, recording 45.2% more claims than the standard regional baseline profile for TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $484.03 across this reporting matrix range.

Provider Avg Cost Per Claim

$10.76

State Avg Cost Per Claim

$23.67

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Clinical Summary

A synthetic tetracycline derivative with similar antimicrobial activity.

Therapeutic Applications

This medication is used to treat a wide variety of bacterial infections, including those that cause acne. This medication is also used to prevent malaria. This medication is known as a tetracycline antibiotic. It works by stopping the growth of bacteria. This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

Gabapentin

Generic Formulation: GabapentinSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 13
30-Day Fills 13.0
Days Supply 350
TX State Average Benchmarks
Peer Average Claims94.0
Peer Average 30-Day Fills159.7
Peer Average Days Supply4,701
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 86.2% less volume than the regional standard for practitioners inside TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $153.41 across this reporting matrix range.

Provider Avg Cost Per Claim

$11.80

State Avg Cost Per Claim

$21.94

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Clinical Summary

A cyclohexane-gamma-aminobutyric acid derivative that is used for the treatment of PARTIAL SEIZURES; NEURALGIA; and RESTLESS LEGS SYNDROME.

Therapeutic Applications

Gabapentin is used with other medications to prevent and control seizures. It is also used to relieve nerve pain following shingles (a painful rash due to herpes zoster infection) in adults. Gabapentin is known as an anticonvulsant or antiepileptic drug.

Hydrocodone-Acetaminophen

Generic Formulation: Hydrocodone/AcetaminophenSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 19
30-Day Fills 19.0
Days Supply 93
TX State Average Benchmarks
Peer Average Claims121.0
Peer Average 30-Day Fills121.4
Peer Average Days Supply2,775
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 84.3% less volume than the regional standard for practitioners inside TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $99.51 across this reporting matrix range.

Provider Avg Cost Per Claim

$5.24

State Avg Cost Per Claim

$24.84

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Therapeutic Applications

This combination medication is used to relieve moderate to severe pain. It contains an opioid pain reliever (hydrocodone) and a non-opioid pain reliever (acetaminophen). Hydrocodone works in the brain to change how your body feels and responds to pain. Acetaminophen can also reduce a fever.

Meclizine Hcl

Generic Formulation: Meclizine HclSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 11
30-Day Fills 11.0
Days Supply 54
TX State Average Benchmarks
Peer Average Claims25.0
Peer Average 30-Day Fills31.6
Peer Average Days Supply731
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 56.0% less volume than the regional standard for practitioners inside TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $45.94 across this reporting matrix range.

Provider Avg Cost Per Claim

$4.18

State Avg Cost Per Claim

$13.16

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Therapeutic Applications

Meclizine is an antihistamine that is used to prevent and treat nausea, vomiting, and dizziness caused by motion sickness. It may also be used to reduce dizziness and loss of balance (vertigo) caused by inner ear problems.

Meloxicam

Generic Formulation: MeloxicamSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 15
30-Day Fills 15.0
Days Supply 450
TX State Average Benchmarks
Peer Average Claims56.0
Peer Average 30-Day Fills94.1
Peer Average Days Supply2,771
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 73.2% less volume than the regional standard for practitioners inside TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $38.45 across this reporting matrix range.

Provider Avg Cost Per Claim

$2.56

State Avg Cost Per Claim

$6.87

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Clinical Summary

A benzothiazine and thiazole derivative that acts as a NSAID and cyclooxygenase-2 (COX-2) inhibitor. It is used in the treatment of RHEUMATOID ARTHRITIS; OSTEOARTHRITIS; and ANKYLOSING SPONDYLITIS.

Therapeutic Applications

Meloxicam is used to help relieve moderate to severe pain. Meloxicam is known as a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking your body's production of certain natural substances that cause inflammation. This effect helps to decrease swelling or pain.

Methylprednisolone

Generic Formulation: MethylprednisoloneSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 73
30-Day Fills 73.0
Days Supply 438
TX State Average Benchmarks
Peer Average Claims35.0
Peer Average 30-Day Fills36.3
Peer Average Days Supply243
Highly Elevated Utilization

This provider exhibits a high preference for this treatment path, registering a volume 108.6% higher than the standard regional baseline profile for TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $711.81 across this reporting matrix range.

Provider Avg Cost Per Claim

$9.75

State Avg Cost Per Claim

$10.10

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Clinical Summary

A PREDNISOLONE derivative with similar anti-inflammatory action.

Therapeutic Applications

Methylprednisolone is used to treat conditions such as arthritis, blood disorders, severe allergic reactions, certain cancers, eye conditions, skin/kidney/intestinal/lung diseases, and immune system disorders. It decreases your immune system's response to various diseases to reduce symptoms such as swelling, pain, and allergic-type reactions. This medication is a corticosteroid hormone. Methylprednisolone may also be used with other medications in hormone disorders.

Metronidazole

Generic Formulation: MetronidazoleSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 11
30-Day Fills 11.0
Days Supply 83
TX State Average Benchmarks
Peer Average Claims13.0
Peer Average 30-Day Fills13.0
Peer Average Days Supply41
Standard Average Utilization

This provider's prescribing patterns for this therapeutic formulation sit directly in line with standard baseline averages across TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $83.31 across this reporting matrix range.

Provider Avg Cost Per Claim

$7.57

State Avg Cost Per Claim

$19.06

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Clinical Summary

A nitroimidazole used to treat AMEBIASIS; VAGINITIS; TRICHOMONAS INFECTIONS; GIARDIASIS; ANAEROBIC BACTERIA; and TREPONEMAL INFECTIONS.

Therapeutic Applications

This medication is used on the skin to treat a certain skin disorder known as rosacea, a type of adult acne. It may help to decrease redness, swelling and the number of pimples caused by rosacea. This medication is an antibiotic. For the treatment of rosacea, metronidazole is believed to work by decreasing swelling (inflammation). Some brands of this medication also contain sunscreens (see also Notes section).

Naproxen

Generic Formulation: NaproxenSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 16
30-Day Fills 16.0
Days Supply 240
TX State Average Benchmarks
Peer Average Claims29.0
Peer Average 30-Day Fills38.0
Peer Average Days Supply982
Conservative Utilization

This provider writes prescriptions for this formulation 44.8% less frequently than the standard regional baseline metric for practitioners inside TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $75.66 across this reporting matrix range.

Provider Avg Cost Per Claim

$4.73

State Avg Cost Per Claim

$29.57

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Clinical Summary

An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout.

Therapeutic Applications

Naproxen is used to relieve mild to moderate pain from various conditions. It also reduces pain, swelling, and joint stiffness from arthritis. This medication is known as a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking your body's production of certain natural substances that cause inflammation. If you are treating a chronic condition such as arthritis, ask your doctor about non-drug treatments and/or using other medications to treat your pain. See also Warning section. This form of naproxen is absorbed slowly and should not be used for pain that needs quick relief (such as during a gout attack). Ask your doctor or pharmacist about using a different form of this drug or other medications for quick relief of pain.

Ondansetron Odt

Generic Formulation: OndansetronSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 40
30-Day Fills 40.0
Days Supply 137
TX State Average Benchmarks
Peer Average Claims24.0
Peer Average 30-Day Fills25.0
Peer Average Days Supply266
Highly Elevated Utilization

This provider exhibits a high preference for this treatment path, registering a volume 66.7% higher than the standard regional baseline profile for TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $293.70 across this reporting matrix range.

Provider Avg Cost Per Claim

$7.34

State Avg Cost Per Claim

$22.90

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Clinical Summary

A competitive serotonin type 3 receptor antagonist. It is effective in the treatment of nausea and vomiting caused by cytotoxic chemotherapy drugs, including cisplatin, and has reported anxiolytic and neuroleptic properties.

Therapeutic Applications

This medication is used alone or with other medications to prevent nausea and vomiting caused by cancer drug treatment (chemotherapy) and radiation therapy. It is also used to prevent and treat nausea and vomiting after surgery. Ondansetron works by blocking one of the body's natural substances (serotonin) that causes vomiting.

Promethazine Hcl

Generic Formulation: Promethazine HclSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 12
30-Day Fills 12.0
Days Supply 61
TX State Average Benchmarks
Peer Average Claims24.0
Peer Average 30-Day Fills25.5
Peer Average Days Supply383
Conservative Utilization

This provider writes prescriptions for this formulation 50.0% less frequently than the standard regional baseline metric for practitioners inside TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $58.03 across this reporting matrix range.

Provider Avg Cost Per Claim

$4.84

State Avg Cost Per Claim

$13.28

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Therapeutic Applications

See also Warning section. Promethazine is used to prevent and treat nausea and vomiting related to certain conditions (such as motion sickness, or before/after surgery). It is also used to treat allergy symptoms such as rash, itching, and runny nose. It may be used to help you feel sleepy/relaxed before and after surgery or to help certain opioid pain relievers (such as meperidine) work better. The suppository form is used when medications cannot be taken by mouth. Promethazine is an antihistamine and works by blocking a certain natural substance (histamine) that your body makes during an allergic reaction. Its other effects (such as anti-nausea, calming, pain relief) may work by affecting other natural substances (such as acetylcholine) and by acting directly on certain parts of the brain.

Tizanidine Hcl

Generic Formulation: Tizanidine HclSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 21
30-Day Fills 21.0
Days Supply 300
TX State Average Benchmarks
Peer Average Claims55.0
Peer Average 30-Day Fills72.3
Peer Average Days Supply1,936
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 61.8% less volume than the regional standard for practitioners inside TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $139.26 across this reporting matrix range.

Provider Avg Cost Per Claim

$6.63

State Avg Cost Per Claim

$14.41

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Therapeutic Applications

This medication is used to treat muscle spasms caused by certain conditions (such as multiple sclerosis, spinal cord injury). It works by helping to relax the muscles.

Tramadol Hcl

Generic Formulation: Tramadol HclSpecialty: Emergency Medicine
Provider Metrics Summary
Total Claims 53
30-Day Fills 53.0
Days Supply 265
TX State Average Benchmarks
Peer Average Claims62.0
Peer Average 30-Day Fills63.6
Peer Average Days Supply1,282
Standard Average Utilization

This provider's prescribing patterns for this therapeutic formulation sit directly in line with standard baseline averages across TX. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $166.96 across this reporting matrix range.

Provider Avg Cost Per Claim

$3.15

State Avg Cost Per Claim

$7.68

Note on Expenses: These indicators represent gross infrastructure resource tracking paid directly to supply pharmacy networks by Medicare Part D configurations. These calculations do not track individual patient insurance tier copays or out-of-pocket shelf prices at retail checkout lanes.

Clinical Summary

A narcotic analgesic proposed for severe pain. It may be habituating.

Therapeutic Applications

See also Warning section. This medication is used to help relieve moderate to moderately severe pain. Tramadol belongs to a class of drugs known as opioid analgesics. It works in the brain to change how your body feels and responds to pain.

Dataset Methodology & CMS Source Information

This analytical profile maps public infrastructure records sourced directly from official **Centers for Medicare & Medicaid Services (CMS)** public data releases. The statistics above track documented pharmaceutical treatment trends assigned to beneficiaries specifically under federal public programs. Evaluating the prescriptive footprints of clinical practitioners like ARUNA AKUNDI MD provides transparency into local medical care patterns within Kaufman, TX.

Key Learning Objectives for this Profile:

  • Prescribing Frequencies: Track and evaluate the volume metrics of specific brand-name and generic medical formulas chosen by this provider over time.
  • Clinical Focus Areas: Identify how the provider distributes therapeutic selections across medical care options to gain insight into their true day-to-day **Emergency Medicine** practice concentrations.
  • Program Cost Awareness: Review the calculated total systemic drug costs and raw transactional volumes linked to these orders to better anticipate network insurance coverage structures.
  • Patient-Centered Evaluation: Cross-reference localized regional care comparisons to align practitioner habits directly with your proactive health maintenance goals.

Data Scope Exclusion & Limitations: The data elements presented above explicitly reflect prescription orders processed for Medicare beneficiaries during the year 2023. This informational profile does not aggregate prescription data for individuals utilizing private commercial health plans, state Medicaid coverage, or self-pay options. However, because medical decision-making remains highly consistent across clinical settings, this public registry provides a reliable proxy for understanding the general prescribing preferences and pharmaceutical care approach used by this provider.