Basil D. Fossum, M.D. PA

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

BASIL D. FOSSUM, M.D. PA

Doing business as

Basil D. Fossum, M.D.

Practice address

914 Mar Walt Dr Ste B
Fort Walton Beach, FL 32547-6706

Phone

(850) 226-6572

Fax

(850) 862-8564

NPI assigned

Jan 20, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Basil Duane Fossum MD PA, M.D.

Title

Owner

Phone

(850) 862-2555

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Basil D. Fossum, M.D. Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747872000000",
    "number": "1154911527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 MAR WALT DR STE B",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476706",
            "telephone_number": "850-862-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 MAR WALT DR STE B",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476706",
            "telephone_number": "850-226-6572",
            "fax_number": "850-862-8564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASIL D. FOSSUM, M.D. PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-20",
        "last_updated": "2025-05-22",
        "certification_date": "2021-03-31",
        "status": "A",
        "authorized_official_last_name": "FOSSUM MD PA",
        "authorized_official_first_name": "BASIL",
        "authorized_official_middle_name": "DUANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-862-2555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME53505",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Basil D. Fossum, M.D.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Basil D. Fossum, M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rebecca Bartlett, DPT
• Keilah Marie Barton, DO
• Sherri Barton, APRN
• J. Brent Bartruff, D.M.D.
• Svetlana Basenspiler
• Basil D. Fossum, M.D., F.a.C.S. (Dr. Fossum)
• Basil Fossum MD PA
• Adhithya Baskar, MD
• Bass Lake Inpatient Services, LLC
• Bassett Family Chiropractic Inc

• Urology Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Urology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.