Carlyn McLean Fostakowsky, R.N., M.S.N., N.P.

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

21062 Issued in CA

Practice address

2001 Santa Monica Blvd Ste 280W
Santa Monica, CA 90404-2172

Phone

(310) 829-7678

Fax

(310) 829-6889

NPI assigned

Feb 7, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Carlyn McLean Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Saint Johns Medical Foundation

  dba Saint John's Physician Partners

  • Specialist
  • Santa Monica, CA
  • NPI 1770093734
  Medicare reassignment NPD

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

{
    "created_epoch": "1328572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1760754659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 SANTA MONICA BLVD",
            "address_2": "SUITE 280W",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042102",
            "telephone_number": "310-829-7678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 SANTA MONICA BLVD STE 280W",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042172",
            "telephone_number": "310-829-7678",
            "fax_number": "310-829-6889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOSTAKOWSKY",
        "first_name": "CARLYN",
        "middle_name": "MCLEAN",
        "name_prefix": "Mrs.",
        "credential": "R.N., M.S.N., N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-07",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "21062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cfostakowsky476018@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "12555 W Jefferson Blvd Ste 303",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900667032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CARLYN",
            "last_name": "MCLEAN",
            "credential": "R.N., M.S.N., N.P.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sheila Forman, PHD
• Constance R. Forrest, PSY.D.
• Forster Physical Therapy
• Forster Physical Therapy, Inc.
• Robert Frank Forster, P.T.
• Kristi Foster, MFC
• Delila Pouldar Foulad, M.D.
• Foundation Behavioral Health LLC
• Foundation Pilates
• Caroline Fournier, MOT, OTR/L

• Acute Care Nurse Practitioner in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Acute Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.