VALERY D TARASENKO M.D.
Prescription History 1912981713
Pain Medicine - Interventional Pain Medicine in Vacaville, CA


Quality Rating: 100 out of 100 score

NPI Status: Active since December 05, 2005

Contact Information

200 BUTCHER RD
VACAVILLE, CA
ZIP 95687
Phone: (707) 359-2255
Fax: (707) 359-2259

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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 VALERY D TARASENKO M.D., an active Interventional Pain Medicine specialist practicing in Vacaville, CA. Our medical registry currently tracks 16 unique pharmaceutical formulations prescribed by this provider, representing an estimated volume of 400 documented patient claims. Among these therapy options, the most frequently utilized medication is Hydrocodone-Acetaminophen, which accounts for 58 claims alone.


Baclofen

Generic Formulation: BaclofenSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 26
30-Day Fills 32.0
Days Supply 960
CA State Average Benchmarks
Peer Average Claims41.0
Peer Average 30-Day Fills55.0
Peer Average Days Supply1,497
Conservative Utilization

This provider writes prescriptions for this formulation 36.6% less frequently than the standard regional baseline metric for practitioners inside CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $812.76 across this reporting matrix range.

Provider Avg Cost Per Claim

$31.26

State Avg Cost Per Claim

$28.61

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 GAMMA-AMINOBUTYRIC ACID derivative that is a specific agonist of GABA-B RECEPTORS. It is used in the treatment of MUSCLE SPASTICITY, especially that due to SPINAL CORD INJURIES. Its therapeutic effects result from actions at spinal and supraspinal sites, generally the reduction of excitatory transmission.

Therapeutic Applications

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

Belbuca

Generic Formulation: Buprenorphine HclSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 17
30-Day Fills 17.0
Days Supply 487
CA State Average Benchmarks
Peer Average Claims41.0
Peer Average 30-Day Fills41.4
Peer Average Days Supply1,207
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 58.5% less volume than the regional standard for practitioners inside CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $14,788.31 across this reporting matrix range.

Provider Avg Cost Per Claim

$869.90

State Avg Cost Per Claim

$725.60

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 derivative of the opioid alkaloid THEBAINE that is a more potent and longer lasting analgesic than MORPHINE. It appears to act as a partial agonist at mu and kappa opioid receptors and as an antagonist at delta receptors. The lack of delta-agonist activity has been suggested to account for the observation that buprenorphine tolerance may not develop with chronic use.

Therapeutic Applications

Buprenorphine is used to help relieve severe ongoing pain. Buprenorphine 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. Do not use this medication to relieve pain that is mild or that will go away in a few days. This medication is not for occasional (as needed) use.

Buprenorphine

Generic Formulation: BuprenorphineSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 23
30-Day Fills 23.0
Days Supply 644
CA State Average Benchmarks
Peer Average Claims35.0
Peer Average 30-Day Fills35.5
Peer Average Days Supply988
Conservative Utilization

This provider writes prescriptions for this formulation 34.3% less frequently than the standard regional baseline metric for practitioners inside CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $7,493.79 across this reporting matrix range.

Provider Avg Cost Per Claim

$325.82

State Avg Cost Per Claim

$345.96

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 derivative of the opioid alkaloid THEBAINE that is a more potent and longer lasting analgesic than MORPHINE. It appears to act as a partial agonist at mu and kappa opioid receptors and as an antagonist at delta receptors. The lack of delta-agonist activity has been suggested to account for the observation that buprenorphine tolerance may not develop with chronic use.

Therapeutic Applications

This medication is used to help relieve severe ongoing pain (such as due to arthritis, chronic back pain). Buprenorphine 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. The higher strengths of this drug (7.5, 10, 15, or 20 micrograms per hour patches) should be used only if you have been regularly taking moderate amounts of opioid pain medication. These strengths may cause overdose (even death) if used by a person who has not been regularly taking opioids. Do not use this medication to relieve pain that is mild or that will go away in a few days. This medication is not for occasional (as needed) use.

Buprenorphine Hcl

Generic Formulation: Buprenorphine HclSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 13
30-Day Fills 13.0
Days Supply 390
CA State Average Benchmarks
Peer Average Claims37.0
Peer Average 30-Day Fills38.1
Peer Average Days Supply1,023
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 64.9% less volume than the regional standard for practitioners inside CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $862.51 across this reporting matrix range.

Provider Avg Cost Per Claim

$66.35

State Avg Cost Per Claim

$67.97

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 derivative of the opioid alkaloid THEBAINE that is a more potent and longer lasting analgesic than MORPHINE. It appears to act as a partial agonist at mu and kappa opioid receptors and as an antagonist at delta receptors. The lack of delta-agonist activity has been suggested to account for the observation that buprenorphine tolerance may not develop with chronic use.

Therapeutic Applications

Buprenorphine is used to help relieve severe ongoing pain. Buprenorphine 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. Do not use this medication to relieve pain that is mild or that will go away in a few days. This medication is not for occasional (as needed) use.

Buprenorphine-Naloxone

Generic Formulation: Buprenorphine Hcl/Naloxone HclSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 15
30-Day Fills 15.0
Days Supply 450
CA State Average Benchmarks
Peer Average Claims41.0
Peer Average 30-Day Fills42.2
Peer Average Days Supply1,065
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 63.4% less volume than the regional standard for practitioners inside CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $2,643.90 across this reporting matrix range.

Provider Avg Cost Per Claim

$176.26

State Avg Cost Per Claim

$199.04

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 contains 2 medicines: buprenorphine and naloxone. It is used to treat opioid dependence/addiction. Buprenorphine belongs to a class of drugs called mixed opioid agonist-antagonists. Buprenorphine helps prevent withdrawal symptoms caused by stopping other opioids. Naloxone is an opioid antagonist that blocks the effect of opioids and can cause severe opioid withdrawal when injected. It has little effect when taken by mouth or dissolved under the tongue. It is combined with buprenorphine to prevent abuse and misuse (injection) of this medication. This combination medication is used as part of a complete treatment program for drug abuse (such as compliance monitoring, counseling, behavioral contract, lifestyle changes). Ask your doctor or pharmacist if you should have other forms of naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it.

Cyclobenzaprine Hcl

Generic Formulation: Cyclobenzaprine HclSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 25
30-Day Fills 25.0
Days Supply 750
CA State Average Benchmarks
Peer Average Claims32.0
Peer Average 30-Day Fills36.6
Peer Average Days Supply955
Standard Average Utilization

This provider's prescribing patterns for this therapeutic formulation sit directly in line with standard baseline averages across CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $550.35 across this reporting matrix range.

Provider Avg Cost Per Claim

$22.01

State Avg Cost Per Claim

$16.68

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.

Therapeutic Applications

Cyclobenzaprine is used short-term to treat muscle spasms. It is usually used along with rest and physical therapy. It works by helping to relax the muscles. This medication is not recommended for use in older adults because they may be at greater risk for side effects while using this drug. Ask the doctor or pharmacist for details.

Diclofenac Sodium

Generic Formulation: Diclofenac SodiumSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 17
30-Day Fills 19.0
Days Supply 547
CA State Average Benchmarks
Peer Average Claims55.0
Peer Average 30-Day Fills62.5
Peer Average Days Supply1,502
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 69.1% less volume than the regional standard for practitioners inside CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $506.60 across this reporting matrix range.

Provider Avg Cost Per Claim

$29.80

State Avg Cost Per Claim

$41.99

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 non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt.

Therapeutic Applications

See also Warning section. This medication is used to relieve joint pain from arthritis. Diclofenac belongs to a class of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs). 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.

Eszopiclone

Generic Formulation: EszopicloneSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 21
30-Day Fills 21.0
Days Supply 630
CA State Average Benchmarks
Peer Average Claims20.0
Peer Average 30-Day Fills23.5
Peer Average Days Supply692
Standard Average Utilization

This provider's prescribing patterns for this therapeutic formulation sit directly in line with standard baseline averages across CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $177.98 across this reporting matrix range.

Provider Avg Cost Per Claim

$8.48

State Avg Cost Per Claim

$47.76

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 pyridine, pyrazine, and piperazine derivative that is used as a HYPNOTIC AND SEDATIVE in the treatment of INSOMNIA.

Therapeutic Applications

This medication is used to treat a certain sleep problem (insomnia). It may help you fall asleep faster, stay asleep longer, and lessen how often you wake up during the night, so you can get a better night's rest. Eszopiclone belongs to a class of drugs called sedative-hypnotics. It acts on your brain to produce a calming effect. Use of this medication is usually limited to short treatment periods of 1 to 2 weeks or less. If your insomnia continues for a longer time, talk to your doctor to see if you need other treatment.

Gabapentin

Generic Formulation: GabapentinSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 38
30-Day Fills 50.0
Days Supply 1,500
CA State Average Benchmarks
Peer Average Claims81.0
Peer Average 30-Day Fills134.7
Peer Average Days Supply3,929
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 53.1% less volume than the regional standard for practitioners inside CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $2,217.83 across this reporting matrix range.

Provider Avg Cost Per Claim

$58.36

State Avg Cost Per Claim

$21.28

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.

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: Interventional Pain Management
Provider Metrics Summary
Total Claims 58
30-Day Fills 58.0
Days Supply 1,600
CA State Average Benchmarks
Peer Average Claims79.0
Peer Average 30-Day Fills79.9
Peer Average Days Supply1,693
Conservative Utilization

This provider writes prescriptions for this formulation 26.6% less frequently than the standard regional baseline metric for practitioners inside CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $1,279.16 across this reporting matrix range.

Provider Avg Cost Per Claim

$22.05

State Avg Cost Per Claim

$22.00

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.

Ibuprofen

Generic Formulation: IbuprofenSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 37
30-Day Fills 38.0
Days Supply 1,140
CA State Average Benchmarks
Peer Average Claims41.0
Peer Average 30-Day Fills45.7
Peer Average Days Supply942
Standard Average Utilization

This provider's prescribing patterns for this therapeutic formulation sit directly in line with standard baseline averages across CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $432.88 across this reporting matrix range.

Provider Avg Cost Per Claim

$11.70

State Avg Cost Per Claim

$9.06

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 non-steroidal anti-inflammatory agent with analgesic, antipyretic, and anti-inflammatory properties

Therapeutic Applications

Ibuprofen is used to help relieve mild to moderate pain. When used with an opioid (such as morphine), it may be used to relieve moderate to severe pain. It is also used to reduce fever. Ibuprofen 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, pain, or fever.

Lidocaine

Generic Formulation: LidocaineSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 14
30-Day Fills 14.0
Days Supply 410
CA State Average Benchmarks
Peer Average Claims38.0
Peer Average 30-Day Fills43.1
Peer Average Days Supply1,207
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 63.2% less volume than the regional standard for practitioners inside CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $2,161.61 across this reporting matrix range.

Provider Avg Cost Per Claim

$154.40

State Avg Cost Per Claim

$170.19

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 local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of PROCAINE but its duration of action is shorter than that of BUPIVACAINE or PRILOCAINE.

Therapeutic Applications

This product is used to help reduce itching and pain from certain skin conditions (such as scrapes, minor skin irritations, insect bites). It may also be used to help relieve nerve pain after shingles (infection with herpes zoster virus). Lidocaine belongs to a class of drugs known as local anesthetics. It works by causing a temporary loss of feeling in the area where you apply the patch.

Oxycodone-Acetaminophen

Generic Formulation: Oxycodone Hcl/AcetaminophenSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 18
30-Day Fills 18.0
Days Supply 531
CA State Average Benchmarks
Peer Average Claims48.0
Peer Average 30-Day Fills48.7
Peer Average Days Supply1,076
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 62.5% less volume than the regional standard for practitioners inside CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $353.15 across this reporting matrix range.

Provider Avg Cost Per Claim

$19.62

State Avg Cost Per Claim

$31.01

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 help relieve moderate to severe pain. It contains an opioid pain reliever (oxycodone) and a non-opioid pain reliever (acetaminophen). Oxycodone works in the brain to change how your body feels and responds to pain. Acetaminophen can also reduce a fever.

Pregabalin

Generic Formulation: PregabalinSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 12
30-Day Fills 12.0
Days Supply 360
CA State Average Benchmarks
Peer Average Claims38.0
Peer Average 30-Day Fills48.7
Peer Average Days Supply1,429
Highly Conservative Utilization

This provider demonstrates a highly selective approach to this formula, recording 68.4% less volume than the regional standard for practitioners inside CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $698.04 across this reporting matrix range.

Provider Avg Cost Per Claim

$58.17

State Avg Cost Per Claim

$47.56

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 gamma-aminobutyric acid (GABA) derivative that functions as a CALCIUM CHANNEL BLOCKER and is used as an ANTICONVULSANT as well as an ANTI-ANXIETY AGENT. It is also used as an ANALGESIC in the treatment of NEUROPATHIC PAIN and FIBROMYALGIA.

Therapeutic Applications

This medication is used to treat pain caused by nerve damage due to diabetes, shingles (herpes zoster) infection, or spinal cord injury. This medication is also used to treat pain in people with fibromyalgia. It is also used with other medications to treat certain types of seizures (focal seizures).

Tizanidine Hcl

Generic Formulation: Tizanidine HclSpecialty: Interventional Pain Management
Provider Metrics Summary
Total Claims 23
30-Day Fills 23.0
Days Supply 690
CA State Average Benchmarks
Peer Average Claims37.0
Peer Average 30-Day Fills45.5
Peer Average Days Supply1,170
Conservative Utilization

This provider writes prescriptions for this formulation 37.8% less frequently than the standard regional baseline metric for practitioners inside CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $883.64 across this reporting matrix range.

Provider Avg Cost Per Claim

$38.42

State Avg Cost Per Claim

$17.54

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: Interventional Pain Management
Provider Metrics Summary
Total Claims 43
30-Day Fills 43.0
Days Supply 1,063
CA State Average Benchmarks
Peer Average Claims43.0
Peer Average 30-Day Fills44.2
Peer Average Days Supply877
Standard Average Utilization

This provider's prescribing patterns for this therapeutic formulation sit directly in line with standard baseline averages across CA. Gross expenditures recorded under Medicare program tracking definitions for this provider calculate to an estimated aggregate of $718.17 across this reporting matrix range.

Provider Avg Cost Per Claim

$16.70

State Avg Cost Per Claim

$7.59

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 VALERY D TARASENKO M.D. provides transparency into local medical care patterns within Vacaville, CA.

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 **Interventional Pain 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.