OrganizationActive
Basil D. Fossum, M.D. PA
NPI 1154911527 · Urology Physician · Fort Walton Beach, FL
Provider details
- NPI number
- 1154911527
- Entity type
- Organization
- Primary specialty
- Urology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Basil Fossum MD PA, Owner(850) 862-2555
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(63/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 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
914 Mar Walt Dr Ste B
Fort Walton Beach, FL 32547-6706
Phone: (850) 226-6572
Fax: (850) 862-8564
Street-level locationGet directions
Mailing address
914 Mar Walt Dr Ste B
Fort Walton Beach, FL 32547-6706
Other names (DBA / former)
- Doing business as
- Basil D. Fossum, M.D.
- Doing business as
- Basil D. Fossum, M.D.
Registry dates
- Enumerated
- 2021-01-20
- Last updated
- 2025-05-22
- Certified
- 2021-03-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.