Basil Fossum MD PA
NPI 1184594962ActiveOrganization· Urology· Fort Walton Beach, FL
Urology in Fort Walton Beach, Florida, registered in NPPES in November 2025. The authorized official on file is Jennifer Lord, Office Manager. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1184594962 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Nov 7, 2025 |
| Last updated in NPPES | Apr 20, 2026 |
| Certified by provider | Apr 20, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Urology Primary | 208800000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (FL) |
|---|
Other Urology providers in Fort Walton Beach
- 1306234174
- 1154911527
- 1235326026
- 1891729026
- 1174768477
- 1427339399
- 1205804432
- 1851331474
- 1821043811
- 1922168830
- 1356317002
- 1790735918