Kenneth Wayne Ponder, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0063310 Issued in FL

Practice address

4566 E Highway 20
Ste 103
Niceville, FL 32578-8838

Phone

(850) 897-1223

Fax

(850) 897-1237

NPI assigned

Feb 18, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Kenneth W Ponder MD PA

  dba Bluewater Medicine

  • Internal Medicine Physician
  • Niceville, FL
  • NPI 1962593574
  Authorized official Same address or phone

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

{
    "created_epoch": "1140220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124093737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4566 E HIGHWAY 20",
            "address_2": "STE 103",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788838",
            "telephone_number": "850-897-1223",
            "fax_number": "850-897-1237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4566 E HIGHWAY 20",
            "address_2": "STE 103",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788838",
            "telephone_number": "850-897-1223",
            "fax_number": "850-897-1237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONDER",
        "first_name": "KENNETH",
        "middle_name": "WAYNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "0063310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janine Phillips, ARNP
• Rebekah Phillips
• Amy Elizabeth Pierce, BCBA
• Zuzana Plesa, EDD
• Laney Elle Plum
• Faith Portz
• Brandie L Postrero, APRN, FNP-C
• Leigh Gayle Powers, DNP
• Jennifer Leah Pratt, LMT
• Prescription Place of Niceville LLC

• Internal Medicine Physician in Niceville, FL
• Providers in Niceville, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.