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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
Sister Sites: OpenMedicaid · OpenFeds · OpenSpending

© 2026 OpenMedicare. Independent data journalism. Built by TheDataProject.ai

Methodology•Download Data
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Data Downloads

Access our complete Medicare spending datasets for research, journalism, and analysis. All 19 datasets are free to download.

Open Data — Free to Use

All data is sourced from public CMS records (2014–2023). Licensed under CC BY 4.0. Please cite OpenMedicare when using our datasets. See our API documentation for programmatic access.

JSON Datasets
19
analysis & research files
Total Data Size
50+ MB
of processed Medicare data
Coverage
2014–2023
10 years of CMS Medicare data

CSV Downloads — Ready for Excel

Pre-formatted CSV files ready for Excel, Google Sheets, or any data tool.

Top Providers Summary

Top 100 Medicare providers by total payments — NPI, name, specialty, state, payments, and services.

CSV
Download

State Summary

All states and territories with total Medicare payments, provider counts, services, and markup ratios.

CSV
Download

Specialty Summary

All 132 medical specialties with total payments, provider counts, and markup ratios.

CSV
Download

Fraud Watchlist

All 500 watchlist providers with risk scores, billing flags, and payment totals.

CSV
Download

Core Data

Essential Medicare spending datasets — providers, states, specialties, and trends.

Top Providers

Top 1,000 Medicare providers by payments

JSONtop-providers.json
Download

Fraud Watchlist

500 providers flagged for billing anomalies

JSONwatchlist.json
Download

States

State-level Medicare spending data

JSONstates.json
Download

Specialties

Specialty-level spending data

JSONspecialties.json
Download

Procedures

Procedure-level spending data

JSONprocedures.json
Download

Trends

10-year spending trends

JSONtrends.json
Download

Fraud Analysis

Anomaly detection and billing investigation datasets.

Fraud Feature Matrix

Fraud feature matrix for 1.14M providers (services/day, markup, etc.)

JSONfraud-features.json
Download

COVID Test Billing

$2.84B in COVID test (K1034) billing analysis

JSONcovid-test-billing.json
Download

Wound Care

$5.53B in wound care billing analysis

JSONwound-care.json
Download

Upcoding Detection

Upcoding detection (99214/99213 ratio analysis)

JSONupcoding.json
Download

ML v2 Results

Machine learning fraud model v2 results — 500 flagged providers with fraud probabilities, risk factors, and markup ratios. Model AUC: 0.83.

JSONml-v2-results.json
Download

Deep Analysis

Detailed breakdowns by geography, place of service, utilization, and more.

Place of Service

Office vs facility spending

JSONplace-of-service.json
Download

Geographic

500 cities, 200 zip codes

JSONgeographic.json
Download

Standardized Payments

Geographic cost adjustments

JSONstandardized-payments.json
Download

Allowed Amounts

Three-way payment gap ($3.22T charged)

JSONallowed-amounts.json
Download

Utilization

Individual vs organization analysis

JSONutilization.json
Download

Markup Analysis

Specialty markup ratios

JSONmarkup-analysis.json
Download

Drug Spending

Drug spending trends

JSONdrug-spending.json
Download

Rural vs Urban

Rural vs urban analysis

JSONrural-urban.json
Download

Detail Files

Individual detail files are also available for each provider, procedure, state, and specialty. Access them via the site or directly:

# Provider detail: /data/providers/{NPI}.json (2,003 files)
# Procedure detail: /data/procedures/{CODE}.json (500 files)
# State detail: /data/states/{CODE}.json (61 files)
# Specialty detail: /data/specialties/{SLUG}.json (105 files)

Developer API

All datasets are available as static JSON files at predictable URLs — no authentication needed. Perfect for building dashboards, research tools, or data journalism projects.

View API Documentation →

Data Dictionary

Key fields used across our datasets.

FieldTypeDescription
npistringNational Provider Identifier — unique 10-digit ID assigned to every Medicare provider
total_paymentsnumberSum of Medicare payments received across all services and years
services_per_daynumberTotal services ÷ 250 working days — flags impossibly high billing volumes
markup_rationumberSubmitted charges ÷ Medicare payments — how much more than the Medicare rate was billed
risk_scorenumberComposite anomaly score (0–100) combining multiple billing flags (watchlist only)
specialty_zscorenumberStandard deviations from specialty median — measures how far a provider deviates from peers
total_chargednumberSum of submitted charges (what provider billed before Medicare adjustments)
total_servicesnumberTotal service line items billed to Medicare
total_beneficiariesnumberUnique Medicare patients served
hcpcs_codestringHealthcare Common Procedure Coding System code identifying specific services
specialtystringCMS-assigned provider specialty classification
fraud_probabilitynumberML model v2 predicted probability of fraud (0–1). Only present in ml-v2-results.json for flagged providers.
risk_ranknumberRank among flagged providers (1 = highest risk). Only in ml-v2-results.json.
top_risk_factorsstring[]Human-readable descriptions of why the provider was flagged (e.g., "Matches confirmed fraud profile")
services_per_benenumberAverage services per beneficiary — high values indicate potential over-utilization
avg_markupnumberAverage markup ratio across all services (watchlist providers)
flagsobject[]Array of billing flags with type, description, and severity (watchlist providers)

Original CMS Source Data

Our data is derived from the CMS Medicare Provider Utilization and Payment dataset. You can access the original source files directly from CMS:

CMS Medicare Provider Data →

Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • CMS National Health Expenditure Data

Last Updated: February 2026 (data through 2023, the latest CMS release)

Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.