How to Look Up Your Doctor's Medicare Billing
Published February 2026 · 8 min read
Why This Matters
Medicare is a public program funded by taxpayers. Every dollar paid to a provider is public record. OpenMedicare makes this data searchable so you can see exactly how much your doctor bills Medicare, what services they provide, and how they compare to peers.
Step 1: Search for Your Provider
Go to the OpenMedicare Provider Lookup page and type your doctor's name, NPI number, specialty, or state. You need at least 2 characters to start searching.
Tip: If your doctor has a common name, add their state abbreviation to narrow results. If you know their NPI (National Provider Identifier) — a unique 10-digit number — that's the most precise search.
What you can search by:
- • Name: "John Smith" or "Smith, John"
- • NPI: 10-digit number like "1234567890"
- • Specialty: "Cardiology" or "Internal Medicine"
- • State: "CA" or "FL"
Step 2: Read the Provider Profile
When you click on a provider, you'll see their full billing profile. Here's what each section means:
Basic Information
- NPI: The provider's unique National Provider Identifier — think of it as their Medicare ID.
- Specialty: Their primary Medicare specialty classification.
- State: Where they practice (based on their Medicare enrollment).
Payment Summary
- Total Payments: How much Medicare has paid this provider over the data period (2014-2023).
- Total Services: The number of individual services billed.
- Total Beneficiaries: How many unique Medicare patients they've treated.
- Submitted Charges: What the provider billed (before Medicare's fee schedule adjustments).
Peer Comparison
OpenMedicare compares each provider to others in the same specialty. This helps you understand whether their billing is typical or unusual. A provider billing 5x the specialty average isn't necessarily fraudulent — they might have a large practice — but it's worth understanding.
Step 3: Understand Fraud Flags
Some provider profiles include fraud risk indicators. These are not accusations — they're statistical flags based on billing patterns that deviate significantly from peer norms. Common flags include:
- ⚠️High volume: Billing significantly more services than peers in the same specialty
- ⚠️High markup: Submitted charges far exceeding Medicare payment amounts
- ⚠️Code concentration: Billing heavily on a small number of high-value codes
- ⚠️Impossible volume: Billing more services per day than is physically possible
What the Data Shows — and Doesn't Show
It's important to understand the limitations of Medicare billing data:
✅ What it shows
- • Total Medicare payments received
- • Services billed and their codes
- • Number of patients served
- • Submitted charges vs. actual payments
- • Year-over-year billing trends
❌ What it doesn't show
- • Quality of care provided
- • Patient outcomes
- • Private insurance billing
- • Out-of-pocket patient costs
- • Practice overhead or net income
CMS Tools vs. OpenMedicare
CMS (Centers for Medicare & Medicaid Services) provides its own lookup tools, including the Medicare Provider Utilization and Payment Data portal. Here's how they compare:
| Feature | CMS Data Portal | OpenMedicare |
|---|---|---|
| Easy provider search | Limited | ✅ Instant search |
| 10-year trends | Year-by-year files | ✅ Pre-aggregated |
| Peer comparison | No | ✅ Built-in |
| Fraud risk flags | No | ✅ Statistical flags |
| Raw data download | ✅ Full datasets | Top providers |
Found Something Suspicious?
If a provider's billing seems unusual, you have options. Check our guide to reporting Medicare fraud, which explains how to file a complaint with the HHS-OIG, understand whistleblower protections, and what qualifies as fraud vs. legitimate billing variation.
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