CLIA lab
CLIA 10D2284940: Basil D Fossum MD PA
Fort Walton Beach, FL. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 10D2284940 belongs to Basil D Fossum MD PA in Fort Walton Beach, FL.
Certificate for Provider-Performed Microscopy Procedures, effective June 30, 2025, expires June 29, 2027.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Run it in Rivvi
Map your lab's test names to LOINC codes
Open in RivviFree to start. Opens Rivvi, the AI workspace for healthcare teams.
Certificate
- Certificate type
- Certificate for Provider-Performed Microscopy Procedures
- Certificate effective
- June 30, 2025
- Certificate expiration
- June 29, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- June 30, 2023
- Facility type
- Physician office
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 10D2284940
- Lab name
- Basil D Fossum MD PA
- Address
- 914-B Marwalt Dr, Fort Walton Beach, FL 32547
- Phone
- (850) 862-2555
- Fax
- (850) 862-8564
Annual test volume the lab reported
- Waived tests
- 100
- Provider-performed microscopy tests
- 1,400
- Total
- 1,500
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Fort Walton Beach, FL
- Advantage Dental Oral Health Center of FL PACertificate of Waiver, Other10D2283268
- Allergy Partners of the Emerald CoastCertificate of Waiver, Physician office10D0978706
- Alternative Living, IncCertificate of Waiver, Assisted living facility10D0953730
- Bay Port Assisted Living IncCertificate of Waiver, Assisted living facility10D2240027
- Belvedere Commons of Fort Walton BeachCertificate of Waiver, Other10D0979325
- Bio Medical Applications of FloridaCertificate of Waiver, End stage renal disease dialysis facility10D2140071
- Biomat USA IncCertificate of Accreditation, Other10D2129840
- Borland Groover Clinic, PACertificate of Waiver, Physician office10D2347719
- Bridgeway Center IncCertificate of Waiver, Other10D0271523
- Brookdale Fort Walton BeachCertificate of Waiver, Assisted living facility10D2105767
Related
Questions
What is the CLIA number for Basil D Fossum MD PA in Fort Walton Beach?
10D2284940, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Basil D Fossum MD PA hold?
A Certificate for Provider-Performed Microscopy Procedures, according to the CMS file.
When does CLIA 10D2284940 expire?
The CMS file lists June 29, 2027 as the certificate expiration date; the certificate took effect June 30, 2025.