Individual provider Active NPI

Charles J. Zeller III, DO

  • Family Medicine Physician
  • Fairborn, OH
National Provider Identifier
1114960820
Registry record updated Sep 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34.002882 Issued in OH
Practice address
1045 Channingway Dr.
Fairborn, OH 45324-9244
Phone
(937) 878-8644
Fax
(937) 878-8646
NPI assigned
Jun 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34.002882 OH Primary

Addresses

Primary practice location

1045 Channingway Dr.
Fairborn, OH 45324-9244

Mailing address

2110 Leiter Rd
Miamisburg, OH 45342-3660
Phone (937) 384-4838

Other identifiers 1

IdentifierTypeStateIssuer
0627147MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180905003067 OH Order and Referring Only - Family PracticePractitioner - Family Practice 7618019266

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
34.002882OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Greene Memorial Hospital Services Inc Family Medicine Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789862400000",
    "number": "1114960820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 LEITER RD",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453423660",
            "telephone_number": "937-384-4838",
            "fax_number": "937-384-4845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 CHANNINGWAY DR.",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453249244",
            "telephone_number": "937-878-8644",
            "fax_number": "937-878-8646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZELLER",
        "first_name": "CHARLES",
        "middle_name": "J.",
        "name_suffix": "III",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2026-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34.002882",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0627147",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairborn, OH

Sources for this page

Verify at the official NPI Registry.