Individual provider Active NPI

Cole Dattel

  • Family Medicine Physician
  • Conway, SC
National Provider Identifier
1104629534
Registry record updated Aug 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
97317 Issued in SC
Practice address
300 Singleton Ridge Rd
Conway, SC 29526-9142
Phone
(843) 347-7111
NPI assigned
Mar 31, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 97317 SC Primary
Student in an Organized Health Care Education/Training Program 390200000X 97317 SC

Addresses

Primary practice location

300 Singleton Ridge Rd
Conway, SC 29526-9142

Mailing address

2526 Annie Baxter Ave
Joplin, MO 64804-0333
Phone (913) 948-0595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20260327000721 SC Order and Referring Only - Family PracticePractitioner - Family Practice 6002391174

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": "1743379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787788800000",
    "number": "1104629534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2526 ANNIE BAXTER AVE",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648040333",
            "telephone_number": "913-948-0595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE RD",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142",
            "telephone_number": "843-347-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DATTEL",
        "first_name": "COLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-03-31",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "97317",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "SC",
            "license": "97317",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

Verify at the official NPI Registry.