Basil D. Fossum (NPI# 1821043811, PAC ID# 7517150055) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is UROLOGY.
| Nation Provider ID (NPI) | 1821043811 |
| PAC ID by PECOS | 7517150055 |
| Professional Enrollment ID | I20101018000299 |
| Full Name | Basil D. Fossum |
| Organization Legal Name | 21ST CENTURY ONCOLOGY, LLC |
| Address |
6879 Us Hwy 98 W Santa Rosa Beach FL 32459-3257 |
| Phone Number | 8506223308 |
| Gender | M |
| Medical School | UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SCHOOL OF MEDICINE |
| Graduation Year | 1972 |
| Primary Specialty | UROLOGY |
| Group Practice PAC ID | 9830082882 |
| Number of Group Practice Members | 297 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 100223 | FORT WALTON BEACH MEDICAL CENTER |
| 100054 | TWIN CITIES HOSPITAL |
| 100292 | SACRED HEART HOSPITAL ON THE EMERALD COAST |
| 100122 | NORTH OKALOOSA MEDICAL CENTER |
| 100266 | GULF BREEZE HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 914 B Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 8502266572 | 21ST CENTURY ONCOLOGY, LLC |
| 6879 Us Hwy 98 W, Santa Rosa Beach, FL 32459-3257 | 8506223308 | 21ST CENTURY ONCOLOGY, LLC |
| Organization Legal Name | 21ST CENTURY ONCOLOGY, LLC |
| Physicians | 306 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sandra E Marrero Ortiz | General Surgery | 21st Century Oncology, LLC | 720 Doctors Dr, Englewood, FL 34223-3992 |
| Eihab Akary | Urology | 21st Century Oncology, LLC | 3325 S Tamiami Trl, Suite 200, Sarasota, FL 34239-5114 |
| Aimiee Michelle Cruz | Nurse Practitioner | 21st Century Oncology, LLC | 16420 Healthpark Commons Dr, Suite 100, Fort Myers, FL 33908-9621 |
| Staci Lin Mitchell | Nurse Practitioner | 21st Century Oncology, LLC | 842 Sunset Lake Blvd, Suite 403, Venice, FL 34292-7553 |
| Nicole B Houle | Nurse Practitioner | 21st Century Oncology, LLC | 1419 Se 8th Ter, Cape Coral, FL 33990-3213 |
| Geoffrey Alan Geiger | Radiation Oncology | 21st Century Oncology, LLC | 3426 N Roosevelt Blvd, Key West, FL 33040-4224 |
| Ashok V.s. Kumar | Hematology/oncology | 21st Century Oncology, LLC | 12741 Miramar Pkwy, Suite 306, Miramar, FL 33027-2905 |
| Donna L Irving | Nurse Practitioner | 21st Century Oncology, LLC | 28930 Trails Edge Boulevard, Suite 200, Bonita Springs, FL 34134-7582 |
| Aurora Y Luna | Diagnostic Radiology | 21st Century Oncology, LLC | 1311 N University Dr, Coral Springs, FL 33071-6622 |
| Elizabeth A Arguelles | General Surgery | 21st Century Oncology, LLC | 733 4th Ave N, Naples, FL 34102-5731 |
| Street Address |
6879 US HWY 98 W |
| City | SANTA ROSA BEACH |
| State | FL |
| Zip | 32459-3257 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Warren R. Amos | Radiation Oncology | 21st Century Oncology, LLC | 6879 Us Hwy 98 W, Santa Rosa Beach, FL 32459-3257 |
| Ravichandra K Sandrapaty | Radiation Oncology | 21st Century Oncology, LLC | 6879 Us Hwy 98 W, Santa Rosa Beach, FL 32459-3257 |
| James H Stevens | Radiation Oncology | 21st Century Oncology, LLC | 6879 Us Hwy 98 W, Santa Rosa Beach, FL 32459-3257 |
| Jayanth G Rao | Radiation Oncology | 21st Century Oncology, LLC | 6879 Us Hwy 98 W, Santa Rosa Beach, FL 32459-3257 |
| Robert E Hruby | General Surgery | 21st Century Oncology, LLC | 6879 Us Hwy 98 W, Santa Rosa Beach, FL 32459-3257 |
| John R Burns | Urology | 21st Century Oncology LLC | 6879 Us Hwy 98 W, Santa Rosa Beach, FL 32459-3257 |
| Michael K Wing | Radiation Oncology | 21st Century Oncology LLC | 6879 Us Hwy 98 W, Santa Rosa Beach, FL 32459-3257 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Renee R Mccormack | Nurse Practitioner | 201 N Blue Heron Dr, Santa Rosa Beach, FL 32459-0201 | |
| Christine Smiley | Family Medicine | Doc Smiley's Urgent Care LLC | 43 Cassine Way, Suite 102, Santa Rosa Beach, FL 32459-0456 |
| Justin T Smiley | Family Medicine | Doc Smiley's Urgent Care LLC | 43 Cassine Way, Suite 102, Santa Rosa Beach, FL 32459-0456 |
| James Benjamin Renfroe | Neurology | Child Neurology Center of Northwest Florida Pa | 23 Mack Bayou Loop, Suite 100, Santa Rosa Beach, FL 32459-2606 |
| Erin D Fowler | Nurse Practitioner | Sacred Heart Hospital of Pensacola | 27 Mack Bayou Loop, Suite 1000, Santa Rosa Beach, FL 32459-2613 |
| Rebecca G Block | Nurse Practitioner | Sacred Heart Hospital of Pensacola | 27 Mack Bayou Loop, Suite 1000, Santa Rosa Beach, FL 32459-2613 |
| Emilia M Banse | Nurse Practitioner | Emerald Coast Memory Clinic LLC | 225 Turquoise Bch Dr, Santa Rosa Beach, FL 32459-3063 |
| Wendy M Depury | Clinical Social Worker | Emerald Coast Memory Clinic LLC | 225 Turquoise Bch Dr, Santa Rosa Beach, FL 32459-3063 |
| Farid Chekaoui | Psychiatry | Emerald Coast Memory Clinic LLC | 225 Turquoise Bch Dr, Santa Rosa Beach, FL 32459-3063 |
| Carmen Y Brezna | Clinical Social Worker | Emerald Coast Memory Clinic LLC | 225 Turquoise Bch Dr, Santa Rosa Beach, FL 32459-3063 |
| Find all physicians in zip 32459 | |||
| City | SANTA ROSA BEACH |
| Zip Code | 32459 |
| Specialty | UROLOGY |
| City + Specialty | SANTA ROSA BEACH + UROLOGY |
Please comment or provide details below to improve the information on Basil D. Fossum.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.