NPIMap

Individual provider Active NPI

Ivan Ivanovich Drazek, PA-C

  • Physician Assistant
  • Fayetteville, NY
National Provider Identifier
1285814616
Registry record updated Oct 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1074875 Issued in NY
Practice address
4000 Medical Center Drive
#115
Fayetteville, NY 13066
Phone
(315) 329-2555
Fax
(315) 744-1957
NPI assigned
Nov 14, 2007
Last updated
Oct 22, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1074875 NY Primary

Addresses

Primary practice location

4000 Medical Center Drive
#115
Fayetteville, NY 13066

Mailing address

307 Broadmoor Dr
Camillus, NY 13031-2443
Phone (315) 777-5798

Other practice location 1

5301 W Genesee St
Camillus, NY 13031-2238
Phone (315) 833-9303

Other practice location 2

301 Prospect Ave
Syracuse, NY 13203-1807
Phone (315) 448-5111

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080523000453 NY Practitioner - Physician Assistant 6608945191 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Country Orthopaedic Group PCGroup PAC ID 8426043381, 18 clinicians

Practice addresses (Care Compare)

1571 Washington St
Suite 201
Watertown, NY 13601-9304
Phone (315) 782-1650

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
012330NYMDPediatric Occupational Therapist
1074875NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Claxton Medical PC Physician Assistant CurrentSince Nov 1, 2025 Accepting new patients
Claxton Medical PC CurrentSince Nov 1, 2025 Accepting new patients
Claxton-Hepburn Medical Center Past Accepting new patients

Locations

3 Lyon Pl
Ogdensburg, NY 13669
Phone (315) 394-7542

3 Lyon Pl
Ste 302
Ogdensburg, NY 13669
Phone (315) 393-7955

Interoperability endpoints

  • Direct secure messaging: ivandrazekpa@ncog.medentdirect.com

Organizations & group practices 4

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792627200000",
    "number": "1285814616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 BROADMOOR DR",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130312443",
            "telephone_number": "315-777-5798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 MEDICAL CENTER DRIVE",
            "address_2": "#115",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "13066",
            "telephone_number": "315-329-2555",
            "fax_number": "315-744-1957"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5301 W Genesee St",
            "address_purpose": "LOCATION",
            "city": "Camillus",
            "state": "NY",
            "postal_code": "130312238",
            "country_code": "US",
            "telephone_number": "315-833-9303",
            "fax_number": "315-833-9992",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 Prospect Ave",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132031807",
            "country_code": "US",
            "telephone_number": "315-448-5111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DRAZEK",
        "first_name": "IVAN",
        "middle_name": "IVANOVICH",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-14",
        "last_updated": "2026-10-22",
        "certification_date": "2026-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "1074875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NY

Sources for this page

Verify at the official NPI Registry.