OrganizationActive
Kenneth W Ponder MD PA
NPI 1962593574 · Internal Medicine Physician · Niceville, FL
Provider details
- NPI number
- 1962593574
- Entity type
- Organization
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kenneth Ponder, President(850) 517-7877
- License
- ME0063310 (FL)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4566 E Highway 20 Ste 103
Niceville, FL 32578-8839
Phone: (850) 897-1223
Fax: (850) 897-1237
Street-level locationGet directions
Mailing address
4704 Knollwood Rd
Niceville, FL 32578-8760
Other names (DBA / former)
- Doing business as
- Bluewater Medicine
- Doing business as
- Bluewater Medicine
Registry dates
- Enumerated
- 2006-09-27
- Last updated
- 2021-12-29
- Certified
- 2021-12-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.