POS HHA Reference Report
Line
Line Descriptions
Value
Type
POS Field
107111
GENTIVA HEALTH SERVICES
BOYNTON BEACH, FL 33437
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Home Health Agency
PROV0075
00020
Change of Ownership Counter
08
PROV0095
00030
Change of Ownership Date
DATE
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
11/02/2006
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00140
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
028101800
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
06/28/1975
PROV1565
00160
Date of Prior Change in Ownership
DATE
11/07/1998
PROV1615
00170
Prior Intermediary Number
CODE
00380
PROV1620
00180
Provider Number
CODE
107111
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
5615405252
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
33437
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
JCAHO
PROV0010
00390
Dieticians
FTES
0.00
PROV0820
00560
Fiscal Year Ending Month/Day
1231
PROV0485
00570
Licensed Practical/Vocational Nurses
FTES
2.00
PROV0955
00580
Occupational Therapists
FTES
0.00
PROV1050
00630
Other Personnel
FTES
0.00
PROV1075
00640
Program Participation - Medicare/Medicaid
Medicare and Medicaid
PROV1670
00680
Region Override #2 for Staffing
Y
PROV1550
00770
Registered Nurses
FTES
14.40
PROV1145
00790
Registered Pharmacists
FTES
0.00
PROV1100
00800
Service - Occupational Therapy
SVCS
Provided under Arrangement
PROV2270
01240
Service - Pharmacy
SVCS
Not Provided
PROV2365
01350
Service - Physicial Therapy
SVCS
Provided by Staff and Arrangement
PROV2370
01360
Type of Facility
0501
PROV2890
01590
Related Provider Number
CODE
PROV1755
02560
Home Health Aide Training and Evaluation Program
2
PROV0555
03420
Agency operates other branches
N
PROV1525
03430
Number of branches operated by this Agency
0
PROV0745
03440
Has HHA undergone a change in ownership
N
PROV0105
03450
HHA can provide Outpatient Physicial Therapy
N
PROV0560
03460
Home Health Aides - Full Time
FTES
10.60
PROV0910
03470
HHA participates with Medicare as a Hospice
N
PROV0665
03480
Medicare Hospice Provider Number
PROV0570
03490
Parent Provider Number for HHA
PROV0650
03500
Social Workers - Full Time
FTES
0.01
PROV1185
03510
Speech Pathologists & Audiologists
FTES
0.01
PROV1220
03520
Appliance and Equipment Maintenance Services
0
PROV2075
03530
Home Health Aid Services
1
PROV2155
03540
Interns and Resident Services
0
PROV2195
03550
Service - Medical Social Services
SVCS
1
PROV2220
03560
Service - Nursing Services
SVCS
1
PROV2250
03570
Nutritional Guidance Services
0
PROV2255
03580
Services - Other Services
SVCS
0
PROV2340
03590
Speech Therapy Services
3
PROV2520
03600
Vocational Guidenance Services
0
PROV2535
03610
Is this HHA a subunit of another HHA
N
PROV2725
03620
Is this HHA an operator of subunit HHAs
N
PROV1530
03630
Number of subunits HHA operated by this HHA
0
PROV1240
03640
Status of Surety Bond for HHA
PROV5680
03650
Physical Therapist - Full Time / On Stall
FTES
3.50
PROV1120
03710
Service - Laboratory Services
SVCS
Not Provided
PROV2200
04340
107150
A VISITING REDI-NURSE
WEST PALM BEACH, FL 33406
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Home Health Agency
PROV0075
00020
Change of Ownership Counter
02
PROV0095
00030
Change of Ownership Date
DATE
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
01/26/2007
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00380
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
04/01/1977
PROV1565
00160
Date of Prior Change in Ownership
DATE
04/01/1981
PROV1615
00170
Prior Intermediary Number
CODE
51100
PROV1620
00180
Provider Number
CODE
107150
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
5614338800
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
33406
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
Dieticians
FTES
0.00
PROV0820
00560
Fiscal Year Ending Month/Day
0430
PROV0485
00570
Licensed Practical/Vocational Nurses
FTES
5.00
PROV0955
00580
Occupational Therapists
FTES
0.00
PROV1050
00630
Other Personnel
FTES
10.00
PROV1075
00640
Program Participation - Medicare/Medicaid
Medicare Only
PROV1670
00680
Region Override #2 for Staffing
Y
PROV1550
00770
Registered Nurses
FTES
20.00
PROV1145
00790
Registered Pharmacists
FTES
0.00
PROV1100
00800
Service - Occupational Therapy
SVCS
Provided under Arrangement
PROV2270
01240
Service - Pharmacy
SVCS
Not Provided
PROV2365
01350
Service - Physicial Therapy
SVCS
Provided under Arrangement
PROV2370
01360
Type of Facility
0507
PROV2890
01590
Related Provider Number
CODE
PROV1755
02560
Home Health Aide Training and Evaluation Program
3
PROV0555
03420
Agency operates other branches
Y
PROV1525
03430
Number of branches operated by this Agency
1
PROV0745
03440
Has HHA undergone a change in ownership
N
PROV0105
03450
HHA can provide Outpatient Physicial Therapy
N
PROV0560
03460
Home Health Aides - Full Time
FTES
9.00
PROV0910
03470
HHA participates with Medicare as a Hospice
N
PROV0665
03480
Medicare Hospice Provider Number
PROV0570
03490
Parent Provider Number for HHA
PROV0650
03500
Social Workers - Full Time
FTES
0.00
PROV1185
03510
Speech Pathologists & Audiologists
FTES
0.00
PROV1220
03520
Appliance and Equipment Maintenance Services
0
PROV2075
03530
Home Health Aid Services
1
PROV2155
03540
Interns and Resident Services
0
PROV2195
03550
Service - Medical Social Services
SVCS
2
PROV2220
03560
Service - Nursing Services
SVCS
1
PROV2250
03570
Nutritional Guidance Services
0
PROV2255
03580
Services - Other Services
SVCS
1
PROV2340
03590
Speech Therapy Services
2
PROV2520
03600
Vocational Guidenance Services
0
PROV2535
03610
Is this HHA a subunit of another HHA
N
PROV2725
03620
Is this HHA an operator of subunit HHAs
N
PROV1530
03630
Number of subunits HHA operated by this HHA
0
PROV1240
03640
Status of Surety Bond for HHA
PROV5680
03650
Physical Therapist - Full Time / On Stall
FTES
0.00
PROV1120
03710
Service - Laboratory Services
SVCS
Not Provided
PROV2200
04340
107210
HOME HEALTH CORPORATION OF AMERICA, INC./FT.PIERCE
BOYNTON BEACH, FL 33426
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Home Health Agency
PROV0075
00020
Change of Ownership Counter
02
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
07/20/2005
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00380
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
09/10/1985
PROV1565
00160
Date of Prior Change in Ownership
DATE
05/01/1990
PROV1615
00170
Prior Intermediary Number
CODE
51100
PROV1620
00180
Provider Number
CODE
107210
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
5616869988
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
33426
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
Dieticians
FTES
0.00
PROV0820
00560
Fiscal Year Ending Month/Day
0630
PROV0485
00570
Licensed Practical/Vocational Nurses
FTES
2.00
PROV0955
00580
Occupational Therapists
FTES
3.00
PROV1050
00630
Other Personnel
FTES
0.00
PROV1075
00640
Program Participation - Medicare/Medicaid
Medicare Only
PROV1670
00680
Region Override #2 for Staffing
Y
PROV1550
00770
Registered Nurses
FTES
17.00
PROV1145
00790
Registered Pharmacists
FTES
0.00
PROV1100
00800
Service - Occupational Therapy
SVCS
Provided by Staff and Arrangement
PROV2270
01240
Service - Pharmacy
SVCS
Not Provided
PROV2365
01350
Service - Physicial Therapy
SVCS
Provided by Staff and Arrangement
PROV2370
01360
Type of Facility
0507
PROV2890
01590
Related Provider Number
CODE
PROV1755
02560
Home Health Aide Training and Evaluation Program
2
PROV0555
03420
Agency operates other branches
Y
PROV1525
03430
Number of branches operated by this Agency
2
PROV0745
03440
Has HHA undergone a change in ownership
N
PROV0105
03450
HHA can provide Outpatient Physicial Therapy
N
PROV0560
03460
Home Health Aides - Full Time
FTES
2.00
PROV0910
03470
HHA participates with Medicare as a Hospice
N
PROV0665
03480
Medicare Hospice Provider Number
PROV0570
03490
Parent Provider Number for HHA
PROV0650
03500
Social Workers - Full Time
FTES
1.00
PROV1185
03510
Speech Pathologists & Audiologists
FTES
1.00
PROV1220
03520
Appliance and Equipment Maintenance Services
0
PROV2075
03530
Home Health Aid Services
3
PROV2155
03540
Interns and Resident Services
0
PROV2195
03550
Service - Medical Social Services
SVCS
1
PROV2220
03560
Service - Nursing Services
SVCS
1
PROV2250
03570
Nutritional Guidance Services
0
PROV2255
03580
Services - Other Services
SVCS
0
PROV2340
03590
Speech Therapy Services
3
PROV2520
03600
Vocational Guidenance Services
0
PROV2535
03610
Is this HHA a subunit of another HHA
N
PROV2725
03620
Is this HHA an operator of subunit HHAs
N
PROV1530
03630
Number of subunits HHA operated by this HHA
0
PROV1240
03640
Status of Surety Bond for HHA
PROV5680
03650
Physical Therapist - Full Time / On Stall
FTES
10.00
PROV1120
03710
Service - Laboratory Services
SVCS
Not Provided
PROV2200
04340
107214
ALLIANCECARE AT BETHESDA
BOYNTON BEACH, FL 33426
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Home Health Agency
PROV0075
00020
Change of Ownership Counter
01
PROV0095
00030
Change of Ownership Date
DATE
12/01/2004
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
05/18/2006
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00380
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
08/29/1985
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
51100
PROV1620
00180
Provider Number
CODE
107214
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
5617357900
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
33426
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
Dieticians
FTES
0.25
PROV0820
00560
Fiscal Year Ending Month/Day
1231
PROV0485
00570
Licensed Practical/Vocational Nurses
FTES
1.00
PROV0955
00580
Occupational Therapists
FTES
2.00
PROV1050
00630
Other Personnel
FTES
0.00
PROV1075
00640
Program Participation - Medicare/Medicaid
Medicare Only
PROV1670
00680
Region Override #2 for Staffing
PROV1550
00770
Registered Nurses
FTES
7.50
PROV1145
00790
Registered Pharmacists
FTES
0.00
PROV1100
00800
Service - Occupational Therapy
SVCS
Provided by Staff and Arrangement
PROV2270
01240
Service - Pharmacy
SVCS
Not Provided
PROV2365
01350
Service - Physicial Therapy
SVCS
Provided by Staff and Arrangement
PROV2370
01360
Type of Facility
0507
PROV2890
01590
Related Provider Number
CODE
PROV1755
02560
Home Health Aide Training and Evaluation Program
2
PROV0555
03420
Agency operates other branches
N
PROV1525
03430
Number of branches operated by this Agency
0
PROV0745
03440
Has HHA undergone a change in ownership
N
PROV0105
03450
HHA can provide Outpatient Physicial Therapy
N
PROV0560
03460
Home Health Aides - Full Time
FTES
2.00
PROV0910
03470
HHA participates with Medicare as a Hospice
N
PROV0665
03480
Medicare Hospice Provider Number
PROV0570
03490
Parent Provider Number for HHA
PROV0650
03500
Social Workers - Full Time
FTES
0.50
PROV1185
03510
Speech Pathologists & Audiologists
FTES
0.00
PROV1220
03520
Appliance and Equipment Maintenance Services
0
PROV2075
03530
Home Health Aid Services
1
PROV2155
03540
Interns and Resident Services
0
PROV2195
03550
Service - Medical Social Services
SVCS
1
PROV2220
03560
Service - Nursing Services
SVCS
1
PROV2250
03570
Nutritional Guidance Services
1
PROV2255
03580
Services - Other Services
SVCS
0
PROV2340
03590
Speech Therapy Services
2
PROV2520
03600
Vocational Guidenance Services
0
PROV2535
03610
Is this HHA a subunit of another HHA
N
PROV2725
03620
Is this HHA an operator of subunit HHAs
N
PROV1530
03630
Number of subunits HHA operated by this HHA
0
PROV1240
03640
Status of Surety Bond for HHA
PROV5680
03650
Physical Therapist - Full Time / On Stall
FTES
4.50
PROV1120
03710
Service - Laboratory Services
SVCS
Not Provided
PROV2200
04340
107229
CARETENDERS
DELRAY BEACH, FL 33445
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Home Health Agency
PROV0075
00020
Change of Ownership Counter
01
PROV0095
00030
Change of Ownership Date
DATE
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
11/24/2004
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00380
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
03/21/1985
PROV1565
00160
Date of Prior Change in Ownership
DATE
10/01/1986
PROV1615
00170
Prior Intermediary Number
CODE
51100
PROV1620
00180
Provider Number
CODE
107229
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
5613811077
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
33445
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
Dieticians
FTES
0.00
PROV0820
00560
Fiscal Year Ending Month/Day
1231
PROV0485
00570
Licensed Practical/Vocational Nurses
FTES
1.00
PROV0955
00580
Occupational Therapists
FTES
1.00
PROV1050
00630
Other Personnel
FTES
0.00
PROV1075
00640
Program Participation - Medicare/Medicaid
Medicare and Medicaid
PROV1670
00680
Region Override #2 for Staffing
Y
PROV1550
00770
Registered Nurses
FTES
4.00
PROV1145
00790
Registered Pharmacists
FTES
0.00
PROV1100
00800
Service - Occupational Therapy
SVCS
Provided by Staff and Arrangement
PROV2270
01240
Service - Pharmacy
SVCS
Not Provided
PROV2365
01350
Service - Physicial Therapy
SVCS
Provided by Staff and Arrangement
PROV2370
01360
Type of Facility
0507
PROV2890
01590
Related Provider Number
CODE
PROV1755
02560
Home Health Aide Training and Evaluation Program
2
PROV0555
03420
Agency operates other branches
Y
PROV1525
03430
Number of branches operated by this Agency
1
PROV0745
03440
Has HHA undergone a change in ownership
N
PROV0105
03450
HHA can provide Outpatient Physicial Therapy
N
PROV0560
03460
Home Health Aides - Full Time
FTES
0.50
PROV0910
03470
HHA participates with Medicare as a Hospice
N
PROV0665
03480
Medicare Hospice Provider Number
PROV0570
03490
Parent Provider Number for HHA
PROV0650
03500
Social Workers - Full Time
FTES
1.00
PROV1185
03510
Speech Pathologists & Audiologists
FTES
0.00
PROV1220
03520
Appliance and Equipment Maintenance Services
0
PROV2075
03530
Home Health Aid Services
1
PROV2155
03540
Interns and Resident Services
0
PROV2195
03550
Service - Medical Social Services
SVCS
1
PROV2220
03560
Service - Nursing Services
SVCS
3
PROV2250
03570
Nutritional Guidance Services
0
PROV2255
03580
Services - Other Services
SVCS
0
PROV2340
03590
Speech Therapy Services
2
PROV2520
03600
Vocational Guidenance Services
0
PROV2535
03610
Is this HHA a subunit of another HHA
N
PROV2725
03620
Is this HHA an operator of subunit HHAs
N
PROV1530
03630
Number of subunits HHA operated by this HHA
0
PROV1240
03640
Status of Surety Bond for HHA
PROV5680
03650
Physical Therapist - Full Time / On Stall
FTES
2.00
PROV1120
03710
Service - Laboratory Services
SVCS
Not Provided
PROV2200
04340
107232
AMEDISYS HOME HEALTH OF PALM BEACH
BOYNTON BEACH, FL 33426
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Home Health Agency
PROV0075
00020
Change of Ownership Counter
06
PROV0095
00030
Change of Ownership Date
DATE
05/01/2004
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
04/06/2005
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00380
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
06/30/1990
PROV1565
00160
Date of Prior Change in Ownership
DATE
09/12/2003
PROV1615
00170
Prior Intermediary Number
CODE
52280
PROV1620
00180
Provider Number
CODE
107232
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
5616375200
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
33426
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
Dieticians
FTES
0.00
PROV0820
00560
Fiscal Year Ending Month/Day
1231
PROV0485
00570
Licensed Practical/Vocational Nurses
FTES
1.80
PROV0955
00580
Occupational Therapists
FTES
0.25
PROV1050
00630
Other Personnel
FTES
0.00
PROV1075
00640
Program Participation - Medicare/Medicaid
Medicare Only
PROV1670
00680
Region Override #2 for Staffing
Y
PROV1550
00770
Registered Nurses
FTES
3.30
PROV1145
00790
Registered Pharmacists
FTES
0.00
PROV1100
00800
Service - Occupational Therapy
SVCS
Provided by Staff and Arrangement
PROV2270
01240
Service - Pharmacy
SVCS
Not Provided
PROV2365
01350
Service - Physicial Therapy
SVCS
Provided by Staff and Arrangement
PROV2370
01360
Type of Facility
0507
PROV2890
01590
Related Provider Number
CODE
PROV1755
02560
Home Health Aide Training and Evaluation Program
2
PROV0555
03420
Agency operates other branches
Y
PROV1525
03430
Number of branches operated by this Agency
3
PROV0745
03440
Has HHA undergone a change in ownership
N
PROV0105
03450
HHA can provide Outpatient Physicial Therapy
N
PROV0560
03460
Home Health Aides - Full Time
FTES
0.10
PROV0910
03470
HHA participates with Medicare as a Hospice
N
PROV0665
03480
Medicare Hospice Provider Number
PROV0570
03490
Parent Provider Number for HHA
PROV0650
03500
Social Workers - Full Time
FTES
0.10
PROV1185
03510
Speech Pathologists & Audiologists
FTES
0.25
PROV1220
03520
Appliance and Equipment Maintenance Services
0
PROV2075
03530
Home Health Aid Services
1
PROV2155
03540
Interns and Resident Services
0
PROV2195
03550
Service - Medical Social Services
SVCS
1
PROV2220
03560
Service - Nursing Services
SVCS
1
PROV2250
03570
Nutritional Guidance Services
0
PROV2255
03580
Services - Other Services
SVCS
0
PROV2340
03590
Speech Therapy Services
3
PROV2520
03600
Vocational Guidenance Services
0
PROV2535
03610
Is this HHA a subunit of another HHA
N
PROV2725
03620
Is this HHA an operator of subunit HHAs
N
PROV1530
03630
Number of subunits HHA operated by this HHA
0
PROV1240
03640
Status of Surety Bond for HHA
PROV5680
03650
Physical Therapist - Full Time / On Stall
FTES
3.25
PROV1120
03710
Service - Laboratory Services
SVCS
Not Provided
PROV2200
04340
107237
INTERIM HC TREASURE COAST INC
WEST PALM BEACH, FL 33409
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Home Health Agency
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
12/22/2005
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00380
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
027268000
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
04/21/1987
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
51100
PROV1620
00180
Provider Number
CODE
107237
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
5616169500
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
33409
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
Dieticians
FTES
0.00
PROV0820
00560
Fiscal Year Ending Month/Day
1231
PROV0485
00570
Licensed Practical/Vocational Nurses
FTES
7.00
PROV0955
00580
Occupational Therapists
FTES
0.00
PROV1050
00630
Other Personnel
FTES
1.00
PROV1075
00640
Program Participation - Medicare/Medicaid
Medicare and Medicaid
PROV1670
00680
Region Override #2 for Staffing
Y
PROV1550
00770
Registered Nurses
FTES
8.00
PROV1145
00790
Registered Pharmacists
FTES
0.00
PROV1100
00800
Service - Occupational Therapy
SVCS
Provided under Arrangement
PROV2270
01240
Service - Pharmacy
SVCS
Not Provided
PROV2365
01350
Service - Physicial Therapy
SVCS
Provided by Staff and Arrangement
PROV2370
01360
Type of Facility
0507
PROV2890
01590
Related Provider Number
CODE
PROV1755
02560
Home Health Aide Training and Evaluation Program
2
PROV0555
03420
Agency operates other branches
N
PROV1525
03430
Number of branches operated by this Agency
0
PROV0745
03440
Has HHA undergone a change in ownership
N
PROV0105
03450
HHA can provide Outpatient Physicial Therapy
N
PROV0560
03460
Home Health Aides - Full Time
FTES
36.00
PROV0910
03470
HHA participates with Medicare as a Hospice
N
PROV0665
03480
Medicare Hospice Provider Number
PROV0570
03490
Parent Provider Number for HHA
PROV0650
03500
Social Workers - Full Time
FTES
1.00
PROV1185
03510
Speech Pathologists & Audiologists
FTES
1.00
PROV1220
03520
Appliance and Equipment Maintenance Services
0
PROV2075
03530
Home Health Aid Services
1
PROV2155
03540
Interns and Resident Services
0
PROV2195
03550
Service - Medical Social Services
SVCS
1
PROV2220
03560
Service - Nursing Services
SVCS
1
PROV2250
03570
Nutritional Guidance Services
0
PROV2255
03580
Services - Other Services
SVCS
0
PROV2340
03590
Speech Therapy Services
1
PROV2520
03600
Vocational Guidenance Services
0
PROV2535
03610
Is this HHA a subunit of another HHA
N
PROV2725
03620
Is this HHA an operator of subunit HHAs
N
PROV1530
03630
Number of subunits HHA operated by this HHA
0
PROV1240
03640
Status of Surety Bond for HHA
PROV5680
03650
Physical Therapist - Full Time / On Stall
FTES
7.00
PROV1120
03710
Service - Laboratory Services
SVCS
Not Provided
PROV2200
04340
107265
ALLIED HOME CARE, INC
BOYNTON BEACH, FL 33426
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Home Health Agency
PROV0075
00020
Change of Ownership Counter
02
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
10/19/2006
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00380
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
08/09/1988
PROV1565
00160
Date of Prior Change in Ownership
DATE
01/13/1989
PROV1615
00170
Prior Intermediary Number
CODE
51100
PROV1620
00180
Provider Number
CODE
107265
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
5613695100
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
33426
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
Dieticians
FTES
0.00
PROV0820
00560
Fiscal Year Ending Month/Day
0430
PROV0485
00570
Licensed Practical/Vocational Nurses
FTES
0.00
PROV0955
00580
Occupational Therapists
FTES
0.00
PROV1050
00630
Other Personnel
FTES
0.00
PROV1075
00640
Program Participation - Medicare/Medicaid
Medicare Only
PROV1670
00680
Region Override #2 for Staffing
PROV1550
00770
Registered Nurses
FTES
6.20
PROV1145
00790
Registered Pharmacists
FTES
0.00
PROV1100
00800
Service - Occupational Therapy
SVCS
Provided under Arrangement
PROV2270
01240
Service - Pharmacy
SVCS
Not Provided
PROV2365
01350
Service - Physicial Therapy
SVCS
Provided under Arrangement
PROV2370
01360
Type of Facility
0507
PROV2890
01590
Related Provider Number
CODE
PROV1755
02560
Home Health Aide Training and Evaluation Program
4
PROV0555
03420
Agency operates other branches
Y
PROV1525
03430
Number of branches operated by this Agency
1
PROV0745
03440
Has HHA undergone a change in ownership
N
PROV0105
03450
HHA can provide Outpatient Physicial Therapy
N
PROV0560
03460
Home Health Aides - Full Time
FTES
0.40
PROV0910
03470
HHA participates with Medicare as a Hospice
N
PROV0665
03480
Medicare Hospice Provider Number
PROV0570
03490
Parent Provider Number for HHA
PROV0650
03500
Social Workers - Full Time
FTES
0.00
PROV1185
03510
Speech Pathologists & Audiologists
FTES
0.05
PROV1220
03520
Appliance and Equipment Maintenance Services
0
PROV2075
03530
Home Health Aid Services
1
PROV2155
03540
Interns and Resident Services
0
PROV2195
03550
Service - Medical Social Services
SVCS
2
PROV2220
03560
Service - Nursing Services
SVCS
1
PROV2250
03570
Nutritional Guidance Services
0
PROV2255
03580
Services - Other Services
SVCS
0
PROV2340
03590
Speech Therapy Services
1
PROV2520
03600
Vocational Guidenance Services
0
PROV2535
03610
Is this HHA a subunit of another HHA
N
PROV2725
03620
Is this HHA an operator of subunit HHAs
N
PROV1530
03630
Number of subunits HHA operated by this HHA
0
PROV1240
03640
Status of Surety Bond for HHA
PROV5680
03650
Physical Therapist - Full Time / On Stall
FTES
0.00
PROV1120
03710
Service - Laboratory Services
SVCS
Not Provided
PROV2200
04340
107271
NURSE ON CALL OF SOUTH FL
LAKE WORTH, FL 33461
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Home Health Agency
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
05/17/2007
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00380
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
10/31/1988
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
51100
PROV1620
00180
Provider Number
CODE
107271
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
5616490830
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
Dieticians
FTES
0.00
PROV0820
00560
Fiscal Year Ending Month/Day
1231
PROV0485
00570
Licensed Practical/Vocational Nurses
FTES
8.00
PROV0955
00580
Occupational Therapists
FTES
0.92
PROV1050
00630
Other Personnel
FTES
0.00
PROV1075
00640
Program Participation - Medicare/Medicaid
Medicare Only
PROV1670
00680
Region Override #2 for Staffing
Y
PROV1550
00770
Registered Nurses
FTES
44.02
PROV1145
00790
Registered Pharmacists
FTES
0.00
PROV1100
00800
Service - Occupational Therapy
SVCS
Provided by Staff and Arrangement
PROV2270
01240
Service - Pharmacy
SVCS
Not Provided
PROV2365
01350
Service - Physicial Therapy
SVCS
Provided by Staff and Arrangement
PROV2370
01360
Type of Facility
0507
PROV2890
01590
Related Provider Number
CODE
PROV1755
02560
Home Health Aide Training and Evaluation Program
4
PROV0555
03420
Agency operates other branches
Y
PROV1525
03430
Number of branches operated by this Agency
2
PROV0745
03440
Has HHA undergone a change in ownership
N
PROV0105
03450
HHA can provide Outpatient Physicial Therapy
N
PROV0560
03460
Home Health Aides - Full Time
FTES
5.34
PROV0910
03470
HHA participates with Medicare as a Hospice
N
PROV0665
03480
Medicare Hospice Provider Number
PROV0570
03490
Parent Provider Number for HHA
PROV0650
03500
Social Workers - Full Time
FTES
0.21
PROV1185
03510
Speech Pathologists & Audiologists
FTES
0.64
PROV1220
03520
Appliance and Equipment Maintenance Services
0
PROV2075
03530
Home Health Aid Services
3
PROV2155
03540
Interns and Resident Services
0
PROV2195
03550
Service - Medical Social Services
SVCS
1
PROV2220
03560
Service - Nursing Services
SVCS
3
PROV2250
03570
Nutritional Guidance Services
2
PROV2255
03580
Services - Other Services
SVCS
0
PROV2340
03590
Speech Therapy Services
3
PROV2520
03600
Vocational Guidenance Services
0
PROV2535
03610
Is this HHA a subunit of another HHA
N
PROV2725
03620
Is this HHA an operator of subunit HHAs
N
PROV1530
03630
Number of subunits HHA operated by this HHA
0
PROV1240
03640
Status of Surety Bond for HHA
PROV5680
03650
Physical Therapist - Full Time / On Stall
FTES
14.43
PROV1120
03710
Service - Laboratory Services
SVCS
Not Provided
PROV2200
04340
6/10/2008
11:45:07AM
C
:
\
DOCUME
~
1
\
ROBERT
~
1
\
LOCALS
~
1
\
Temp
\
temp
_
15855
c
25
-
fcd
8
-
4742
-
968
d
-
a
1362
c
7
d
21
d
4
{
3
AAAC
7
E
5
-
0
EF
3
-
4
B
6
A
-
8
A
50
-
3
DCA
74
B
9
AB
3
F
}
.
rpt
Page 14 of 14
11:45 am
www
.
halmanac
.
com
6/10/2008
Healthcare Almanac
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561
)
228
-
1582