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BASIL FOSSUM MD PA
NPI 1184594962
Urology in Fort Walton Beach, FL

Active since November 07, 2025
914B MAR WALT DR, FORT WALTON BEACH, FL 32547(850) 862-2555(850) 862-8564 Get Directions Write a Review

NPPES record last updated: April 20, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 20, 2026, Dec 3, 2025, Nov 7, 2025 (3 updates tracked since 2025).

About Basil Fossum Md Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BASIL FOSSUM MD PA (NPI 1184594962) is a healthcare organization registered as an urology in Fort Walton Beach, Florida and active in the NPI registry since November 2025. The organization lists Jennifer Lord, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1184594962
Entity TypeOrganization
Primary Taxonomy208800000X
Legal Business NameBASIL FOSSUM MD PA
Location Address914B MAR WALT DRFort Walton Beach, FL 32547-6706
Mailing Address914b Mar Walt DrFort Walton Beach, FL 32547-6706 · (850) 862-2555 · Fax (850) 862-8564
Phone(850) 862-2555
Fax(850) 862-8564
Organization SubpartNo
Authorized OfficialJennifer LordOffice Manager · (850) 862-2555
Enumeration DateNovember 7, 2025
Last NPPES UpdateApril 20, 20263 updates tracked since enumeration
NPPES CertifiedApril 20, 2026
✔ NPI 1184594962 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyUrologyAllopathic & Osteopathic Physicians
Taxonomy Code208800000X
Definition
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.
914B MAR WALT DR, Fort Walton Beach, FL 32547
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Basil Fossum Md Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Basil Fossum MD PA, which bills Medicare for the services this clinician delivers.

Clinician (1)

Basil Fossum
Urology
NPI 1821043811
914B MAR WALT DR
Fort Walton Beach, FL 32547
(850) 226-6572
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Basil Fossum MD PA's NPI number?

The NPI number for Basil Fossum MD PA is 1184594962. It was assigned to this organization in the NPPES registry on November 7, 2025.

Where is Basil Fossum MD PA located?

Basil Fossum MD PA is located at 914B Mar Walt Dr, Fort Walton Beach, FL 32547. The listed phone number is (850) 862-2555.

What is Basil Fossum MD PA's specialty?

The primary specialty registered for this NPI is Urology with taxonomy code 208800000X.

Is Basil Fossum MD PA enrolled in Medicare?

Yes. Basil Fossum MD PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Basil Fossum MD PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Urology) reassigns their Medicare billing to Basil Fossum MD PA. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Basil Fossum MD PA was last updated on April 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.