POS ASCTR Reference Report
Line
Line Descriptions
Value
Type
POS Field
10C0001024
PALM BEACH OUTPATIENT SURGICAL CENTER
LAKE WORTH, FL 33461
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Ambulatory Surgical Cente
PROV0075
00020
Change of Ownership Counter
02
PROV0095
00030
Change of Ownership Date
DATE
07/30/2004
PROV0100
00040
Provider has Correction Plan for Deficiencies
PROV0220
00060
Provider in Compliance with Correction Plan
In Compliance
PROV2715
00070
Provider County
490
PROV2695
00080
Old Provider Number for this Provider
CODE
PROV0300
00090
Current FMS Survey Date
DATE
PROV0500
00100
Official Survey Date
DATE
06/29/2006
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00590
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
0758621 00
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
09/20/1985
PROV1565
00160
Date of Prior Change in Ownership
DATE
06/01/2000
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
10C0001024
PROV1680
00190
Current Status of Record
Accepted
PROV1720
00200
CMS Regional Office for Provider
Atlanta
PROV1725
00210
Skeleton Record Indicator
PROV2045
00220
Provider State
FL
PROV3230
00230
SSA State Code
10
PROV2700
00240
State Region Code (in selected states)
LAN
PROV2710
00250
Provider Telephone Number
4079690139
PROV1605
00270
Termination Reason Code
Active
PROV4770
00280
Termination Date/Expriation Date
DATE
PROV4500
00290
Type of Action for Transmittal
Recertification
PROV2880
00300
Type of Control for Provider
Proprietary
PROV2885
00310
Provider Zip Code
33461
PROV2905
00320
Provider FIPS State
12
FIPSTATE
00330
Provider FIPS County
12099
FIPCNTY
00340
SSA MSA Code
637
SSAMSACD
00350
SSA MSA Size Code
C
SSAMSASZ
00360
Accreditation Indicator
None
PROV0010
00390
Compliance - Life Safety Code
CMPL
PROV0240
00480
Fiscal Year Ending Month/Day
1231
PROV0485
00570
Service - Pharmacy
SVCS
Provided under Arrangement
PROV2365
01350
Related Provider Number
CODE
PROV1755
02560
Services - Other Services
SVCS
N
PROV2340
03590
Date Facility Began Providing Service
DATE
01/01/1982
PROV0415
04170
Is Facility Free Standing?
Y
PROV0550
04180
Provider uses Hospital Based Indicators
PROV0565
04190
Number of Operating Rooms
2
PROV1055
04200
Service - Cardiovascular Surgery
SVCS
N
PROV2095
04210
Service - Foot Surgery
SVCS
N
PROV2145
04220
Service - General Surgery
SVCS
N
PROV2150
04230
Service - Neurological Surgery
SVCS
N
PROV2240
04240
Service - Obstetrics/Gynecology Surgery
SVCS
N
PROV2260
04250
Service - Opthamology Surgery
SVCS
Y
PROV2290
04260
Service - Oral Surgery
SVCS
N
PROV2305
04270
Service - Orthopedic Surgery
SVCS
N
PROV2320
04280
Service - Otolaryngology Surgery
SVCS
N
PROV2345
04290
Service - Plastic Surgery
SVCS
N
PROV2400
04300
Service - Thoracic Surgery
SVCS
N
PROV2525
04310
Service - Urology Surgery
SVCS
N
PROV2530
04320
Service - EKG Testing
SVCS
Provided under Arrangement
PROV2135
04330
Service - Laboratory Services
SVCS
Provided under Arrangement
PROV2200
04340
10C0001042
VISUAL HEALTH AT JUPITER EYE CENTER
JUPITER, FL 33477
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Ambulatory Surgical Cente
PROV0075
00020
Change of Ownership Counter
01
PROV0095
00030
Change of Ownership Date
DATE
10/12/2001
PROV0100
00040
Provider has Correction Plan for Deficiencies
Compliance Based on Acceptable POC
PROV0220
00060
Provider in Compliance with Correction Plan
In Compliance
PROV2715
00070
Provider County
490
PROV2695
00080
Old Provider Number for this Provider
CODE
PROV0300
00090
Current FMS Survey Date
DATE
PROV0500
00100
Official Survey Date
DATE
06/22/2006
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00590
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
075141300
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
09/14/1987
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
10C0001042
PROV1680
00190
Current Status of Record
Accepted
PROV1720
00200
CMS Regional Office for Provider
Atlanta
PROV1725
00210
Skeleton Record Indicator
PROV2045
00220
Provider State
FL
PROV3230
00230
SSA State Code
10
PROV2700
00240
State Region Code (in selected states)
LAN
PROV2710
00250
Provider Telephone Number
4077471111
PROV1605
00270
Termination Reason Code
Active
PROV4770
00280
Termination Date/Expriation Date
DATE
PROV4500
00290
Type of Action for Transmittal
Recertification
PROV2880
00300
Type of Control for Provider
Proprietary
PROV2885
00310
Provider Zip Code
33477
PROV2905
00320
Provider FIPS State
12
FIPSTATE
00330
Provider FIPS County
12099
FIPCNTY
00340
SSA MSA Code
637
SSAMSACD
00350
SSA MSA Size Code
C
SSAMSASZ
00360
Accreditation Indicator
None
PROV0010
00390
Compliance - Life Safety Code
CMPL
PROV0240
00480
Fiscal Year Ending Month/Day
1231
PROV0485
00570
Service - Pharmacy
SVCS
Provided under Arrangement
PROV2365
01350
Related Provider Number
CODE
PROV1755
02560
Services - Other Services
SVCS
N
PROV2340
03590
Date Facility Began Providing Service
DATE
07/31/2004
PROV0415
04170
Is Facility Free Standing?
Y
PROV0550
04180
Provider uses Hospital Based Indicators
PROV0565
04190
Number of Operating Rooms
2
PROV1055
04200
Service - Cardiovascular Surgery
SVCS
N
PROV2095
04210
Service - Foot Surgery
SVCS
N
PROV2145
04220
Service - General Surgery
SVCS
N
PROV2150
04230
Service - Neurological Surgery
SVCS
N
PROV2240
04240
Service - Obstetrics/Gynecology Surgery
SVCS
N
PROV2260
04250
Service - Opthamology Surgery
SVCS
Y
PROV2290
04260
Service - Oral Surgery
SVCS
N
PROV2305
04270
Service - Orthopedic Surgery
SVCS
N
PROV2320
04280
Service - Otolaryngology Surgery
SVCS
N
PROV2345
04290
Service - Plastic Surgery
SVCS
N
PROV2400
04300
Service - Thoracic Surgery
SVCS
N
PROV2525
04310
Service - Urology Surgery
SVCS
N
PROV2530
04320
Service - EKG Testing
SVCS
Provided under Arrangement
PROV2135
04330
Service - Laboratory Services
SVCS
Provided under Arrangement
PROV2200
04340
10C0001054
PALM BEACH EYE CLINIC
WEST PALM BEACH, FL 33407
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Ambulatory Surgical Cente
PROV0075
00020
Change of Ownership Counter
00
PROV0095
00030
Change of Ownership Date
DATE
PROV0100
00040
Provider has Correction Plan for Deficiencies
PROV0220
00060
Provider in Compliance with Correction Plan
Not In Compliance
PROV2715
00070
Provider County
490
PROV2695
00080
Old Provider Number for this Provider
CODE
PROV0300
00090
Current FMS Survey Date
DATE
PROV0500
00100
Official Survey Date
DATE
07/06/2004
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00590
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
079048600
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
11/06/1987
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
10C0001054
PROV1680
00190
Current Status of Record
Accepted
PROV1720
00200
CMS Regional Office for Provider
Atlanta
PROV1725
00210
Skeleton Record Indicator
PROV2045
00220
Provider State
FL
PROV3230
00230
SSA State Code
10
PROV2700
00240
State Region Code (in selected states)
LAN
PROV2710
00250
Provider Telephone Number
4078326113
PROV1605
00270
Termination Reason Code
Active
PROV4770
00280
Termination Date/Expriation Date
DATE
PROV4500
00290
Type of Action for Transmittal
Recertification
PROV2880
00300
Type of Control for Provider
Proprietary
PROV2885
00310
Provider Zip Code
33407
PROV2905
00320
Provider FIPS State
12
FIPSTATE
00330
Provider FIPS County
12099
FIPCNTY
00340
SSA MSA Code
637
SSAMSACD
00350
SSA MSA Size Code
C
SSAMSASZ
00360
Accreditation Indicator
None
PROV0010
00390
Compliance - Life Safety Code
CMPL
PROV0240
00480
Fiscal Year Ending Month/Day
1031
PROV0485
00570
Service - Pharmacy
SVCS
Provided under Arrangement
PROV2365
01350
Related Provider Number
CODE
PROV1755
02560
Services - Other Services
SVCS
N
PROV2340
03590
Date Facility Began Providing Service
DATE
01/01/1987
PROV0415
04170
Is Facility Free Standing?
Y
PROV0550
04180
Provider uses Hospital Based Indicators
PROV0565
04190
Number of Operating Rooms
1
PROV1055
04200
Service - Cardiovascular Surgery
SVCS
N
PROV2095
04210
Service - Foot Surgery
SVCS
N
PROV2145
04220
Service - General Surgery
SVCS
N
PROV2150
04230
Service - Neurological Surgery
SVCS
N
PROV2240
04240
Service - Obstetrics/Gynecology Surgery
SVCS
N
PROV2260
04250
Service - Opthamology Surgery
SVCS
Y
PROV2290
04260
Service - Oral Surgery
SVCS
N
PROV2305
04270
Service - Orthopedic Surgery
SVCS
N
PROV2320
04280
Service - Otolaryngology Surgery
SVCS
N
PROV2345
04290
Service - Plastic Surgery
SVCS
N
PROV2400
04300
Service - Thoracic Surgery
SVCS
N
PROV2525
04310
Service - Urology Surgery
SVCS
N
PROV2530
04320
Service - EKG Testing
SVCS
Provided under Arrangement
PROV2135
04330
Service - Laboratory Services
SVCS
Provided under Arrangement
PROV2200
04340
10C0001057
PRESIDENTIAL SURGICENTER
WEST PALM BEACH, FL 33401
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Ambulatory Surgical Cente
PROV0075
00020
Change of Ownership Counter
00
PROV0095
00030
Change of Ownership Date
DATE
PROV0100
00040
Provider has Correction Plan for Deficiencies
PROV0220
00060
Provider in Compliance with Correction Plan
In Compliance
PROV2715
00070
Provider County
490
PROV2695
00080
Old Provider Number for this Provider
CODE
PROV0300
00090
Current FMS Survey Date
DATE
PROV0500
00100
Official Survey Date
DATE
10/12/1999
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00590
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
079229200
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
06/26/1987
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
10C0001057
PROV1680
00190
Current Status of Record
Accepted
PROV1720
00200
CMS Regional Office for Provider
Atlanta
PROV1725
00210
Skeleton Record Indicator
PROV2045
00220
Provider State
FL
PROV3230
00230
SSA State Code
10
PROV2700
00240
State Region Code (in selected states)
LAN
PROV2710
00250
Provider Telephone Number
4076894500
PROV1605
00270
Termination Reason Code
Active
PROV4770
00280
Termination Date/Expriation Date
DATE
PROV4500
00290
Type of Action for Transmittal
Recertification
PROV2880
00300
Type of Control for Provider
Proprietary
PROV2885
00310
Provider Zip Code
33401
PROV2905
00320
Provider FIPS State
12
FIPSTATE
00330
Provider FIPS County
12099
FIPCNTY
00340
SSA MSA Code
637
SSAMSACD
00350
SSA MSA Size Code
C
SSAMSASZ
00360
Accreditation Indicator
None
PROV0010
00390
Compliance - Life Safety Code
CMPL
PROV0240
00480
Fiscal Year Ending Month/Day
1231
PROV0485
00570
Service - Pharmacy
SVCS
Provided under Arrangement
PROV2365
01350
Related Provider Number
CODE
PROV1755
02560
Services - Other Services
SVCS
N
PROV2340
03590
Date Facility Began Providing Service
DATE
06/23/1987
PROV0415
04170
Is Facility Free Standing?
Y
PROV0550
04180
Provider uses Hospital Based Indicators
PROV0565
04190
Number of Operating Rooms
1
PROV1055
04200
Service - Cardiovascular Surgery
SVCS
N
PROV2095
04210
Service - Foot Surgery
SVCS
N
PROV2145
04220
Service - General Surgery
SVCS
N
PROV2150
04230
Service - Neurological Surgery
SVCS
N
PROV2240
04240
Service - Obstetrics/Gynecology Surgery
SVCS
N
PROV2260
04250
Service - Opthamology Surgery
SVCS
Y
PROV2290
04260
Service - Oral Surgery
SVCS
N
PROV2305
04270
Service - Orthopedic Surgery
SVCS
N
PROV2320
04280
Service - Otolaryngology Surgery
SVCS
N
PROV2345
04290
Service - Plastic Surgery
SVCS
N
PROV2400
04300
Service - Thoracic Surgery
SVCS
N
PROV2525
04310
Service - Urology Surgery
SVCS
N
PROV2530
04320
Service - EKG Testing
SVCS
Provided under Arrangement