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Risk scores are statistical indicators based on prescribing patterns compared to specialty peers. They are NOT allegations of fraud, misconduct, or improper care. Many legitimate medical reasons can explain outlier prescribing.

Read our methodology →

Pooja BaijalM.D.

Family Practice · Los Banos, CA 93635

NPI: 1336281583

Share:

39

🟠 Elevated

Risk Flags

Extreme opioid rate vs specialty peers95th percentile opioid prescribingHigh long-acting opioid rate vs peers

Risk indicators are statistical patterns, not allegations. Learn more

182

Total Claims

$5,245

Drug Cost

41

Beneficiaries

$128

Cost/Patient

Risk Score Breakdown 39/100

Low (0)Moderate (15)Elevated (30)High (50+)
Opioid rate vs specialty peers+25
Long-acting opioid rate+8
Opioid rate (national percentile)+6

Score components are additive. Read full methodology

Peer Comparison vs. 106,889 Family Practice providers

+2073%

Opioid rate vs peers

56.0% vs 2.6% avg

-88%

Cost per patient vs peers

$128 vs $1,068 avg

⚠️ This provider has metrics more than 3 standard deviations above their specialty average in one or more categories.

🔎 Data Overview

⚠️

Opioid prescribing rate is 2,073% above the average for Family Practice providers. While some providers legitimately treat pain-heavy populations, deviations of this magnitude are rare and warrant examination.

Insights generated from CMS data analysis. Statistical patterns are not accusations — always consider clinical context.

Opioid Prescribing

56.0%

Opioid Rate

102

Opioid Claims

$3,154

Opioid Cost

49.0%

Long-Acting Rate

This provider's opioid prescribing rate of 56.0% is above the 20% threshold that CMS considers elevated.

Brand vs Generic

100% generic

Brand: 0 claims · $0

Generic: 170 claims · $3,484

Patient Profile

78

Avg Age

66%

Female

2.58

Avg Risk Score

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Data from CMS Medicare Part D Prescriber Public Use File, 2023. Risk scores are statistical indicators, not allegations.Methodology · About