POS Labs Reference Report
Line
Line Descriptions
Value
Type
POS Field
10D0024830
REHABILITATION CENTER OF PALM BEACHES
WEST PALM BEACH, FL 33407
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
CLIA/Lab
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
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
PROV2740
00110
Eligibility for Medicare/Mediciad
PROV0455
00120
Intermediary/Carrier Servicing Provider
PROV0605
00140
Date Approved for Medicare/Medicaid
DATE
01/14/1993
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
10D0024830
PROV1680
00190
Current Status of Record
Accepted
PROV1720
00200
CMS Regional Office for Provider
Atlanta
PROV1725
00210
Skeleton Record Indicator
Skeleton record with limited data
PROV2045
00220
Provider State
FL
PROV3230
00230
SSA State Code
10
PROV2700
00240
State Region Code (in selected states)
FTM
PROV2710
00250
Provider Telephone Number
5617121717
PROV1605
00270
Termination Reason Code
Active
PROV4770
00280
Termination Date/Expriation Date
DATE
08/31/2008
PROV4500
00290
Type of Action for Transmittal
PROV2880
00300
Type of Control for Provider
Other
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
Fiscal Year Ending Month/Day
PROV0485
00570
Type of Facility
2218
PROV2890
01590
Accredited by American Assoc of Blood Banks AABB
PROV4205
04570
Accredited by American Osteopathic Assoc AOA
PROV4200
04580
Acc by Am. Soc. for Histocomp & Immun. ASHI
PROV4225
04590
Accredited by College of American Pathologists
PROV4210
04600
Accredited by Commission on Off. Lab Acc. COLA
PROV4215
04610
Accredited by JCAHO
PROV4195
04620
Acc Date by American Assoc of Blood Banks AABB
DATE
PROV5040
04630
Acc Date by American Osteopathic Assoc AOA
DATE
PROV5045
04640
Acc Date by Am. Soc. for Histocomp. & Immun. ASHI
DATE
PROV5055
04650
Acc Date by College of American Pathologist
DATE
PROV5060
04660
Acc Date by Commission on Off Lab Acc COLA
DATE
PROV5065
04670
Acc Date by JCAHO
DATE
PROV5070
04680
Member of American Assoc of Blood Banks AABB
PROV4970
04690
Member of American Osteopathic Assoc AOA
PROV4975
04700
Member of Am. Soc for Histocomp & Immun ASHI
PROV4985
04710
Member of College of American Pathologist CAP
PROV4990
04720
Member of Commission of Off Lab Acc COLA
PROV4960
04730
Member of JCAHO
PROV4995
04740
Affiliated CLIA Number 1
PROV4240
04750
Affiliated CLIA Number 2
PROV4245
04760
Affiliated CLIA Number 3
PROV4250
04770
Affiliated CLIA Number 4
PROV4255
04780
Affiliated CLIA Number 5
PROV4260
04790
Affiliated CLIA Number 6
PROV4265
04800
Affiliated CLIA Number 7
PROV4270
04810
Affiliated CLIA Number 8
PROV4275
04820
Accredited Annual Test Volume
0
PROV4390
04830
Application Accrued Schedule Code
PROV4365
04840
Application Received Date
DATE
01/14/1993
PROV4340
04850
Application Total Annual Test Volume
0
PROV4325
04860
Application Type
2
PROV4695
04870
Certificate Type Code
2
PROV3810
04880
Certificate Mailed Date
DATE
08/05/2006
PROV4700
04890
CLIA Certificate Effective Date
DATE
09/01/2006
PROV3860
04900
CLIA Medicare Number
105039
PROV4885
04910
Laboratory Classification
00
PROV5935
04920
Fax Phone Number
5617121118
PROV5800
04930
Laboratory Classification 1
Non Exempt Lab
PROV5945
04940
Laboratory Classification 10
PROV5940
04950
Laboratory Classification 2
Non Exempt Lab
PROV5955
04960
Laboratory Classification 3
Non Exempt Lab
PROV5965
04970
Laboratory Classification 4
Non Exempt Lab
PROV5990
04980
Laboratory Classification 5
Non Exempt Lab
PROV5985
04990
Laboratory Classification 6
Non Exempt Lab
PROV5975
05000
Laboratory Classification 7
Non Exempt Lab
PROV5970
05010
Laboratory Classification 8
Non Exempt Lab
PROV5960
05020
Laboratory Classification 9
PROV5950
05030
Miltiple Site Certificate Indicator
N
PROV4175
05040
Non-Profit Code
PROV4190
05050
Total Number of Non-Waived Individuals
0
PROV4330
05060
Number of Clinical Consultants
FTES
0
PROV4295
05070
Number of Directors
FTES
0
PROV4290
05080
Number of General Supervisors
FTES
0
PROV4310
05090
Number of Lab Sites
0
PROV4180
05100
Number of Labs Directly Affiliated
0
PROV4235
05110
Number of Technical Consultants
FTES
0
PROV4300
05120
Number of Technical Supervisors
FTES
0
PROV4305
05130
Number of Testing Personnel
FTES
0
PROV4315
05140
Number of Waived Individuals
FTES
0
PROV4285
05150
Pending Laboratory Classification
PROV5980
05160
Licensed under CLIA 67
N
PROV3610
05170
Shared Lab Cross Reference Number
PROV4890
05180
Shared Lab Indicator
PROV4880
05190
Survey Certificate Schedule Code
PROV4470
05200
Survey Compliance Schedule Code
PROV4475
05210
Survey Test Volume
0
PROV4460
05220
Termination Code
00
PROV5805
05230
Total Waived Test Volume
0
PROV4280
05240
10D0024866
COLUMBIA HOSPITAL CLINICAL LABORATORY
WEST PALM BEACH, FL 33407
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
CLIA/Lab
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
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
PROV2740
00110
Eligibility for Medicare/Mediciad
PROV0455
00120
Intermediary/Carrier Servicing Provider
PROV0605
00140
Date Approved for Medicare/Medicaid
DATE
02/11/1993
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
10D0024866
PROV1680
00190
Current Status of Record
Accepted
PROV1720
00200
CMS Regional Office for Provider
Atlanta
PROV1725
00210
Skeleton Record Indicator
Skeleton record with limited data
PROV2045
00220
Provider State
FL
PROV3230
00230
SSA State Code
10
PROV2700
00240
State Region Code (in selected states)
FTM
PROV2710
00250
Provider Telephone Number
5618633941
PROV1605
00270
Termination Reason Code
Active
PROV4770
00280
Termination Date/Expriation Date
DATE
02/08/2009
PROV4500
00290
Type of Action for Transmittal
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
Fiscal Year Ending Month/Day
PROV0485
00570
Type of Facility
2210
PROV2890
01590
Accredited by American Assoc of Blood Banks AABB
PROV4205
04570
Accredited by American Osteopathic Assoc AOA
PROV4200
04580
Acc by Am. Soc. for Histocomp & Immun. ASHI
PROV4225
04590
Accredited by College of American Pathologists
X
PROV4210
04600
Accredited by Commission on Off. Lab Acc. COLA
PROV4215
04610
Accredited by JCAHO
PROV4195
04620
Acc Date by American Assoc of Blood Banks AABB
DATE
PROV5040
04630
Acc Date by American Osteopathic Assoc AOA
DATE
PROV5045
04640
Acc Date by Am. Soc. for Histocomp. & Immun. ASHI
DATE
PROV5055
04650
Acc Date by College of American Pathologist
DATE
02/09/1995
PROV5060
04660
Acc Date by Commission on Off Lab Acc COLA
DATE
PROV5065
04670
Acc Date by JCAHO
DATE
PROV5070
04680
Member of American Assoc of Blood Banks AABB
PROV4970
04690
Member of American Osteopathic Assoc AOA
PROV4975
04700
Member of Am. Soc for Histocomp & Immun ASHI
PROV4985
04710
Member of College of American Pathologist CAP
Y
PROV4990
04720
Member of Commission of Off Lab Acc COLA
PROV4960
04730
Member of JCAHO
PROV4995
04740
Affiliated CLIA Number 1
PROV4240
04750
Affiliated CLIA Number 2
PROV4245
04760
Affiliated CLIA Number 3
PROV4250
04770
Affiliated CLIA Number 4
PROV4255
04780
Affiliated CLIA Number 5
PROV4260
04790
Affiliated CLIA Number 6
PROV4265
04800
Affiliated CLIA Number 7
PROV4270
04810
Affiliated CLIA Number 8
PROV4275
04820
Accredited Annual Test Volume
523694
PROV4390
04830
Application Accrued Schedule Code
I
PROV4365
04840
Application Received Date
DATE
02/11/1993
PROV4340
04850
Application Total Annual Test Volume
0
PROV4325
04860
Application Type
3
PROV4695
04870
Certificate Type Code
3
PROV3810
04880
Certificate Mailed Date
DATE
01/13/2007
PROV4700
04890
CLIA Certificate Effective Date
DATE
02/09/2007
PROV3860
04900
CLIA Medicare Number
100234
PROV4885
04910
Laboratory Classification
00
PROV5935
04920
Fax Phone Number
5618456272
PROV5800
04930
Laboratory Classification 1
Non Exempt Lab
PROV5945
04940
Laboratory Classification 10
PROV5940
04950
Laboratory Classification 2
Non Exempt Lab
PROV5955
04960
Laboratory Classification 3
Non Exempt Lab
PROV5965
04970
Laboratory Classification 4
Non Exempt Lab
PROV5990
04980
Laboratory Classification 5
Non Exempt Lab
PROV5985
04990
Laboratory Classification 6
Non Exempt Lab
PROV5975
05000
Laboratory Classification 7
Non Exempt Lab
PROV5970
05010
Laboratory Classification 8
Non Exempt Lab
PROV5960
05020
Laboratory Classification 9
PROV5950
05030
Miltiple Site Certificate Indicator
N
PROV4175
05040
Non-Profit Code
Y
PROV4190
05050
Total Number of Non-Waived Individuals
36
PROV4330
05060
Number of Clinical Consultants
FTES
2
PROV4295
05070
Number of Directors
FTES
1
PROV4290
05080
Number of General Supervisors
FTES
0
PROV4310
05090
Number of Lab Sites
0
PROV4180
05100
Number of Labs Directly Affiliated
0
PROV4235
05110
Number of Technical Consultants
FTES
0
PROV4300
05120
Number of Technical Supervisors
FTES
1
PROV4305
05130
Number of Testing Personnel
FTES
30
PROV4315
05140
Number of Waived Individuals
FTES
0
PROV4285
05150
Pending Laboratory Classification
PROV5980
05160
Licensed under CLIA 67
Y
PROV3610
05170
Shared Lab Cross Reference Number
PROV4890
05180
Shared Lab Indicator
PROV4880
05190
Survey Certificate Schedule Code
PROV4470
05200
Survey Compliance Schedule Code
PROV4475
05210
Survey Test Volume
0
PROV4460
05220
Termination Code
00
PROV5805
05230
Total Waived Test Volume
0
PROV4280
05240
10D0024930
GLADES CORRECTIONAL INSTITUTION
BELLE GLADE, FL 33430
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
CLIA/Lab
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
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
PROV2740
00110
Eligibility for Medicare/Mediciad
PROV0455
00120
Intermediary/Carrier Servicing Provider
PROV0605
00140
Date Approved for Medicare/Medicaid
DATE
12/23/1992
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
10D0024930
PROV1680
00190
Current Status of Record
Accepted
PROV1720
00200
CMS Regional Office for Provider
Atlanta
PROV1725
00210
Skeleton Record Indicator
Skeleton record with limited data
PROV2045
00220
Provider State
FL
PROV3230
00230
SSA State Code
10
PROV2700
00240
State Region Code (in selected states)
LAB
PROV2710
00250
Provider Telephone Number
5618291440
PROV1605
00270
Termination Reason Code
Active
PROV4770
00280
Termination Date/Expriation Date
DATE
08/31/2008
PROV4500
00290
Type of Action for Transmittal
PROV2880
00300
Type of Control for Provider
Government - State
PROV2885
00310
Provider Zip Code
33430
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
Fiscal Year Ending Month/Day
PROV0485
00570
Type of Facility
2227
PROV2890
01590
Accredited by American Assoc of Blood Banks AABB
PROV4205
04570
Accredited by American Osteopathic Assoc AOA
PROV4200
04580
Acc by Am. Soc. for Histocomp & Immun. ASHI
PROV4225
04590
Accredited by College of American Pathologists
PROV4210
04600
Accredited by Commission on Off. Lab Acc. COLA
PROV4215
04610
Accredited by JCAHO
PROV4195
04620
Acc Date by American Assoc of Blood Banks AABB
DATE
PROV5040
04630
Acc Date by American Osteopathic Assoc AOA
DATE
PROV5045
04640
Acc Date by Am. Soc. for Histocomp. & Immun. ASHI
DATE
PROV5055
04650
Acc Date by College of American Pathologist
DATE
PROV5060
04660
Acc Date by Commission on Off Lab Acc COLA
DATE
PROV5065
04670
Acc Date by JCAHO
DATE
PROV5070
04680
Member of American Assoc of Blood Banks AABB
PROV4970
04690
Member of American Osteopathic Assoc AOA
PROV4975
04700
Member of Am. Soc for Histocomp & Immun ASHI
PROV4985
04710
Member of College of American Pathologist CAP
PROV4990
04720
Member of Commission of Off Lab Acc COLA
PROV4960
04730
Member of JCAHO
PROV4995
04740
Affiliated CLIA Number 1
PROV4240
04750