Active NPI
Gregory John Pataky, APA-C
- Medical Physician Assistant
- Fort Drum, NY
National Provider Identifier
1821076324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 11050 Mt Belvedere Blvd
USA Meddac Attn: Credentials
Fort Drum, NY 13602-5004 - Phone
- (315) 772-4025
- Fax
- (315) 772-9498
- NPI assigned
- Jan 4, 2006
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | Primary |
Addresses
Primary practice location
11050 Mt Belvedere Blvd
USA Meddac Attn: Credentials
Fort Drum, NY 13602-5004
Mailing address
11050 Mt Belvedere Blvd
USA Meddac Attn: Credentials
Fort Drum, NY 13602-5004
Phone (315) 772-4025
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1821076324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11050 MT BELVEDERE BLVD",
"address_2": "USA MEDDAC ATTN: CREDENTIALS",
"city": "FORT DRUM",
"state": "NY",
"postal_code": "136025004",
"telephone_number": "315-772-4025",
"fax_number": "315-772-9498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11050 MT BELVEDERE BLVD",
"address_2": "USA MEDDAC ATTN: CREDENTIALS",
"city": "FORT DRUM",
"state": "NY",
"postal_code": "136025004",
"telephone_number": "315-772-4025",
"fax_number": "315-772-9498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATAKY",
"first_name": "GREGORY",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "APA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-04",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fort Drum, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.