POS Hospice Reference Report
Line
Line Descriptions
Value
Type
POS Field
101500
COMMUNITY HOSPICE OF NORTHEAST
JACKSONVILLE, FL 32207
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Hospice
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
150
PROV2695
00080
Old Provider Number for this Provider
CODE
PROV0300
00090
Current FMS Survey Date
DATE
PROV0500
00100
Official Survey Date
DATE
03/24/2006
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00380
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
087407800
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
11/01/1983
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
51100
PROV1620
00180
Provider Number
CODE
101500
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)
JAX
PROV2710
00250
Provider Telephone Number
9043984724
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
Voluntary Non Profit - Private
PROV2885
00310
Provider Zip Code
32207
PROV2905
00320
Provider FIPS State
12
FIPSTATE
00330
Provider FIPS County
12031
FIPCNTY
00340
SSA MSA Code
264
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
0930
PROV0485
00570
Licensed Practical/Vocational Nurses
FTES
48.00
PROV0955
00580
Other Personnel
FTES
0.00
PROV1075
00640
Registered Nurses
FTES
275.00
PROV1145
00790
Service - Occupational Therapy
SVCS
Provided under Arrangement
PROV2270
01240
Service - Physicial Therapy
SVCS
Provided under Arrangement
PROV2370
01360
Service - Speech Pathology
SVCS
Provided under Arrangement
PROV2505
01520
Type of Facility
1605
PROV2890
01590
Related Provider Number
CODE
PROV1755
02560
Home Health Aides - Full Time
FTES
85.00
PROV0910
03470
Service - Medical Social Services
SVCS
1
PROV2220
03560
Service - Nursing Services
SVCS
1
PROV2250
03570
Services - Other Services
SVCS
0
PROV2340
03590
Total number of employees
FTES
47400
PROV2850
03880
Physicians Employed by Provider
FTES
6.00
PROV1110
03920
Service - Physicains
SVCS
Provided by Staff
PROV2385
04040
Service - Acute/Respite Care
SVCS
C
PROV0015
04360
Counselors - Stall
FTES
8.00
PROV1225
04370
Counselors - Volunteer
FTES
0.00
PROV1480
04380
Home Health Aides - Volunteer
FTES
0.00
PROV1485
04390
Homemaker - Staff
FTES
0.00
PROV0915
04400
Homemaker - Volunteer
FTES
0.00
PROV1490
04410
LPNS/LVNS - Volunteer
FTES
0.00
PROV1495
04420
Medical Social Workers
FTES
52.00
PROV0975
04430
Medical Social Workers - Volunteer
FTES
0.00
PROV1510
04440
Physicians - Volunteer
FTES
0.00
PROV1500
04450
Registered Nurses - Volunteer
FTES
0.00
PROV1505
04460
Service - Counseling
SVCS
1
PROV2115
04470
Service - Home Health Aide
SVCS
1
PROV2165
04480
Service - Homemaker
SVCS
2
PROV2170
04490
Service - Medical Supplies
SVCS
1
PROV2225
04500
Service - Short Term Inpatient Care
SVCS
1
PROV2480
04510
Volunteers - Other
FTES
795.00
PROV1080
04520
Volunteers - Total
FTES
79500
PROV2860
04530
101502
HOSPICE CARE OF SOUTHEAST FLA INC
FORT LAUDERDALE, FL 33316
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Hospice
PROV0075
00020
Change of Ownership Counter
00
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
050
PROV2695
00080
Old Provider Number for this Provider
CODE
PROV0300
00090
Current FMS Survey Date
DATE
PROV0500
00100
Official Survey Date
DATE
03/20/2001
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
11/01/1983
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
51100
PROV1620
00180
Provider Number
CODE
101502
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)
LAU
PROV2710
00250
Provider Telephone Number
3054677423
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
Voluntary Non Profit - Private
PROV2885
00310
Provider Zip Code
33316
PROV2905
00320
Provider FIPS State
12
FIPSTATE
00330
Provider FIPS County
12011
FIPCNTY
00340
SSA MSA Code
196
SSAMSACD
00350
SSA MSA Size Code
B
SSAMSASZ
00360
Accreditation Indicator
JCAHO
PROV0010
00390
Compliance - Life Safety Code
CMPL
PROV0240
00480
Fiscal Year Ending Month/Day
0630
PROV0485
00570
Licensed Practical/Vocational Nurses
FTES
42.00
PROV0955
00580
Other Personnel
FTES
52.00
PROV1075
00640
Registered Nurses
FTES
37.00
PROV1145
00790
Service - Occupational Therapy
SVCS
Provided under Arrangement
PROV2270
01240
Service - Physicial Therapy
SVCS
Provided under Arrangement
PROV2370
01360
Service - Speech Pathology
SVCS
Provided under Arrangement
PROV2505
01520
Type of Facility
1605
PROV2890
01590
Related Provider Number
CODE
PROV1755
02560
Home Health Aides - Full Time
FTES
28.00
PROV0910
03470
Service - Medical Social Services
SVCS
1
PROV2220
03560
Service - Nursing Services
SVCS
1
PROV2250
03570
Services - Other Services
SVCS
0
PROV2340
03590
Total number of employees
FTES
17450
PROV2850
03880
Physicians Employed by Provider
FTES
1.00
PROV1110
03920
Service - Physicains
SVCS
Provided by Staff
PROV2385
04040
Service - Acute/Respite Care
SVCS
C
PROV0015
04360
Counselors - Stall
FTES
7.00
PROV1225
04370
Counselors - Volunteer
FTES
0.00
PROV1480
04380
Home Health Aides - Volunteer
FTES
0.00
PROV1485
04390
Homemaker - Staff
FTES
0.50
PROV0915
04400
Homemaker - Volunteer
FTES
0.00
PROV1490
04410
LPNS/LVNS - Volunteer
FTES
0.00
PROV1495
04420
Medical Social Workers
FTES
7.00
PROV0975
04430
Medical Social Workers - Volunteer
FTES
0.00
PROV1510
04440
Physicians - Volunteer
FTES
0.00
PROV1500
04450
Registered Nurses - Volunteer
FTES
0.00
PROV1505
04460
Service - Counseling
SVCS
1
PROV2115
04470
Service - Home Health Aide
SVCS
1
PROV2165
04480
Service - Homemaker
SVCS
1
PROV2170
04490
Service - Medical Supplies
SVCS
2
PROV2225
04500
Service - Short Term Inpatient Care
SVCS
2
PROV2480
04510
Volunteers - Other
FTES
0.00
PROV1080
04520
Volunteers - Total
FTES
0
PROV2860
04530
101503
VITAS HEALTHCARE OF CENTRAL FL
ORLANDO, FL 32804
T
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Hospice
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
470
PROV2695
00080
Old Provider Number for this Provider
CODE
PROV0300
00090
Current FMS Survey Date
DATE
PROV0500
00100
Official Survey Date
DATE
05/03/2006
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00380
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
150004000
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
11/01/1983
PROV1565
00160
Date of Prior Change in Ownership
DATE
08/09/1996
PROV1615
00170
Prior Intermediary Number
CODE
00450
PROV1620
00180
Provider Number
CODE
101503
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)
ORL
PROV2710
00250
Provider Telephone Number
4078750028
PROV1605
00270
Termination Reason Code
Voluntary - Merge,Close
PROV4770
00280
Termination Date/Expriation Date
DATE
08/01/2007
PROV4500
00290
Type of Action for Transmittal
Recertification
PROV2880
00300
Type of Control for Provider
Proprietary - Corporation
PROV2885
00310
Provider Zip Code
32804
PROV2905
00320
Provider FIPS State
12
FIPSTATE
00330
Provider FIPS County
12095
FIPCNTY
00340
SSA MSA Code
431
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
0930
PROV0485
00570
Licensed Practical/Vocational Nurses
FTES
190.00
PROV0955
00580
Other Personnel
FTES
89.00
PROV1075
00640
Registered Nurses
FTES
151.00
PROV1145
00790
Service - Occupational Therapy
SVCS
Provided under Arrangement
PROV2270
01240
Service - Physicial Therapy
SVCS
Provided under Arrangement
PROV2370
01360
Service - Speech Pathology
SVCS
Provided under Arrangement
PROV2505
01520
Type of Facility
1605
PROV2890
01590
Related Provider Number
CODE
PROV1755
02560
Home Health Aides - Full Time
FTES
146.00
PROV0910
03470
Service - Medical Social Services
SVCS
1
PROV2220
03560
Service - Nursing Services
SVCS
1
PROV2250
03570
Services - Other Services
SVCS
0
PROV2340
03590
Total number of employees
FTES
60500
PROV2850
03880
Physicians Employed by Provider
FTES
10.00
PROV1110
03920
Service - Physicains
SVCS
Provided by Staff
PROV2385
04040
Service - Acute/Respite Care
SVCS
C
PROV0015
04360
Counselors - Stall
FTES
1.00
PROV1225
04370
Counselors - Volunteer
FTES
0.00
PROV1480
04380
Home Health Aides - Volunteer
FTES
0.00
PROV1485
04390
Homemaker - Staff
FTES
0.00
PROV0915
04400
Homemaker - Volunteer
FTES
0.00
PROV1490
04410
LPNS/LVNS - Volunteer
FTES
0.00
PROV1495
04420
Medical Social Workers
FTES
18.00
PROV0975
04430
Medical Social Workers - Volunteer
FTES
0.00
PROV1510
04440
Physicians - Volunteer
FTES
0.00
PROV1500
04450
Registered Nurses - Volunteer
FTES
0.00
PROV1505
04460
Service - Counseling
SVCS
1
PROV2115
04470
Service - Home Health Aide
SVCS
1
PROV2165
04480
Service - Homemaker
SVCS
0
PROV2170
04490
Service - Medical Supplies
SVCS
1
PROV2225
04500
Service - Short Term Inpatient Care
SVCS
1
PROV2480
04510
Volunteers - Other
FTES
245.00
PROV1080
04520
Volunteers - Total
FTES
24500
PROV2860
04530
101504
HOSPICE BY THE SEA INC
BOCA RATON, FL 33486
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Hospice
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
02/19/2003
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00380
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150