NPIMap

Individual provider Active NPI

Desmond Recardo Ponder, MD

  • Family Medicine Physician
  • Myrtle Beach, SC
National Provider Identifier
1184206674
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
86042 Issued in SC
Practice address
5010 Carolina Forest Blvd
Myrtle Beach, SC 29579-3579
Phone
(843) 236-2700
Fax
(843) 236-2726
NPI assigned
Apr 23, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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 86042 SC Primary

Addresses

Primary practice location

5010 Carolina Forest Blvd
Myrtle Beach, SC 29579-3579

Mailing address

300 Singleton Ridge Rd
Attention PNS Credentialing
Conway, SC 29526-9142
Phone (843) 234-6946

Other practice location 1

4022 Postal Way
Myrtle Beach, SC 29579-3537
Phone (843) 236-0000

Other identifiers 1

IdentifierTypeStateIssuer
860429MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20240816000680 SC Practitioner - Family Practice 9830583988 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conway Hospital IncGroup PAC ID 7113839606, 127 clinicians

Practice addresses (Care Compare)

4022 Postal Way
Myrtle Beach, SC 29579-3537
Phone (843) 236-0000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
52.78 of 100Reported as group
Quality
55.48
Improvement activities
0
Cost
74.21

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Hospital, Inc. CurrentSince Aug 1, 2024 Accepting new patients
Conway Hospital, Inc. CurrentSince Aug 1, 2024 Accepting new patients
Conway Hospital, Inc. Past Accepting new patients

Locations

394 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 347-8050

300 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 234-6946

4022 Postal Way
Myrtle Beach, SC 29579
Phone (843) 236-0000

5010 Carolina Forest Blvd
Myrtle Beach, SC 29579
Phone (843) 236-2700

Organizations & group practices 3

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

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1619136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1184206674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE RD",
            "address_2": "ATTENTION PNS CREDENTIALING",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142",
            "telephone_number": "843-234-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5010 CAROLINA FOREST BLVD",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295793579",
            "telephone_number": "843-236-2700",
            "fax_number": "843-236-2726"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4022 Postal Way",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295793537",
            "country_code": "US",
            "telephone_number": "843-236-0000",
            "fax_number": "843-236-6191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PONDER",
        "first_name": "DESMOND",
        "middle_name": "RECARDO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-23",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "86042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "860429",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.