Basil Fossum MD PA
NPI 1184594962 · Urology Physician · Fort Walton Beach, FL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Basil Fossum MD PA is a Urology Physician organization in Fort Walton Beach, FL (NPI 1184594962).
Provider details
- NPI number
- 1184594962
- Entity type
- Organization
- Primary specialty
- Urology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jennifer Lord, Office Manager(850) 862-2555
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in 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
Mailing address
Registry dates
- Enumerated
- 2025-11-07
- Last updated
- 2026-04-20
- Certified
- 2026-04-20
Frequently asked questions
- What is Basil Fossum MD PA's NPI number?
- Basil Fossum MD PA's National Provider Identifier (NPI) is 1184594962, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Basil Fossum MD PA?
- Basil Fossum MD PA is classified in the NPPES registry as Urology Physician (Allopathic & Osteopathic Physicians).
- Where is Basil Fossum MD PA located?
- Basil Fossum MD PA's practice location on file with NPPES is 914b Mar Walt Dr, Fort Walton Beach, FL 32547-6706.
- What is Basil Fossum MD PA's phone number?
- The practice phone number listed in the NPPES registry for Basil Fossum MD PA is (850) 862-2555.
- Does Basil Fossum MD PA accept Medicare?
- Basil Fossum MD PA is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Basil Fossum MD PA?
- The authorized official listed on Basil Fossum MD PA's NPPES record is Jennifer Lord, Office Manager. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Basil Fossum MD PA's NPI active?
- Yes — Basil Fossum MD PA's NPI (1184594962) is active in the NPPES registry as of the last update on 2026-04-20.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.