Active NPI
Charles Russell Zachem, D.O
- Surgery Physician
- Beachwood, OH
National Provider Identifier
1053440669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 34001402Z
- Practice address
- 4110 Warrensville Center Rd
Beachwood, OH 44122-7024 - Phone
- (216) 491-6000
- NPI assigned
- Mar 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 34001402Z | OH | Primary |
Addresses
Primary practice location
4110 Warrensville Center Rd
Beachwood, OH 44122-7024
Mailing address
4700 Rockside Rd
Suite 200
Independence, OH 44131-2155
Phone (216) 643-3114
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 56031 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1402 | OH | MD | Chiropractor |
| 34001402Z | OH | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meridia Medical Group, LLC | Past | Accepting new patients | |
| Bailin and Sundaresh, Inc. | Past | Accepting new patients | |
| Northeast Ohio Emergency Affiliates | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Obstetrics & Gynecology Physician
- Euclid, OH
- NPI 1376605899
-
- Specialist
- Warrensville Heights, OH
- NPI 1316992944
-
- Emergency Medicine Physician
- Rocky River, OH
- NPI 1952340812
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1053440669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4700 ROCKSIDE RD",
"address_2": "SUITE 200",
"city": "INDEPENDENCE",
"state": "OH",
"postal_code": "441312155",
"telephone_number": "216-643-3114",
"fax_number": "216-643-3011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4110 WARRENSVILLE CENTER RD",
"city": "BEACHWOOD",
"state": "OH",
"postal_code": "441227024",
"telephone_number": "216-491-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZACHEM",
"first_name": "CHARLES",
"middle_name": "RUSSELL",
"credential": "D.O",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "OH",
"license": "34001402Z",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "56031",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beachwood, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.