POS Rehab Reference Report
Line
Line Descriptions
Value
Type
POS Field
103246
KASHUBA REHABILITATION INC
PALM BEACH GARDENS, FL 33410
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Outpatient Rehabilation
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
10/28/2004
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00090
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
10/29/1997
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
103246
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
5616241457
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
Non Profit Church
PROV2885
00310
Provider Zip Code
33410
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
1231
PROV0485
00570
Service - Occupational Therapy
SVCS
Provided by Staff
PROV2270
01240
Service - Physicial Therapy
SVCS
Provided by Staff
PROV2370
01360
Service - Social Services
SVCS
Provided by Staff and Arrangement
PROV2485
01510
Service - Speech Pathology
SVCS
Provided by Staff
PROV2505
01520
Related Provider Number
CODE
PROV1755
02560
This Provider participates with Physical Therapy
N
PROV1570
03940
Service - Nursing #2
SVCS
PROV6140
03950
Service - Nursing #3
SVCS
PROV6145
03960
Service - Occupational Physical Therapy # 2
SVCS
PROV2275
03970
Service - Occupatiolnal Physical Therapy # 3
SVCS
PROV2280
03980
Service - Orthotic / Prosthetic # 1
SVCS
Not Provided
PROV2325
03990
Service - Orthotic / Prosthetic # 2
SVCS
PROV2330
04000
Service - Orthotic / Prosthetic # 3
SVCS
PROV2335
04010
Service - Physical Therapy # 2
SVCS
PROV2375
04020
Service - Physical Therapy # 3
SVCS
PROV2380
04030
Service - Physicains
SVCS
Provided by Staff
PROV2385
04040
Service - Physicians # 2
SVCS
PROV2390
04050
Service - Physicians # 3
SVCS
PROV2395
04060
Services - Psychological
SVCS
Not Provided
PROV2420
04070
Services - Psychological # 2
SVCS
PROV2425
04080
Services - Psychological # 3
SVCS
PROV2430
04090
Service - Respiratory Care
SVCS
Not Provided
PROV2455
04100
Service - Respiratory Care # 2
SVCS
PROV2460
04110
Service - Respiratory Care # 3
SVCS
PROV2465
04120
Service - Social Services # 2
SVCS
PROV2490
04130
Service - Social Services # 3
SVCS
PROV2495
04140
Service - Speech Pathology # 2
SVCS
PROV2510
04150
Service - Speech Pathology # 2
SVCS
PROV2515
04160
103288
MEDICAL SPECIALISTS OF PALM BC
ATLANTIS, FL 33462
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Outpatient Rehabilation
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
09/01/2004
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00090
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
06/30/1998
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
103288
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
5619687968
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
33462
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
1231
PROV0485
00570
Service - Occupational Therapy
SVCS
Provided by Staff and Arrangement
PROV2270
01240
Service - Physicial Therapy
SVCS
Provided by Staff
PROV2370
01360
Service - Social Services
SVCS
Provided by Staff and Arrangement
PROV2485
01510
Service - Speech Pathology
SVCS
Provided by Staff and Arrangement
PROV2505
01520
Related Provider Number
CODE
PROV1755
02560
This Provider participates with Physical Therapy
N
PROV1570
03940
Service - Nursing #2
SVCS
PROV6140
03950
Service - Nursing #3
SVCS
PROV6145
03960
Service - Occupational Physical Therapy # 2
SVCS
PROV2275
03970
Service - Occupatiolnal Physical Therapy # 3
SVCS
PROV2280
03980
Service - Orthotic / Prosthetic # 1
SVCS
Not Provided
PROV2325
03990
Service - Orthotic / Prosthetic # 2
SVCS
PROV2330
04000
Service - Orthotic / Prosthetic # 3
SVCS
PROV2335
04010
Service - Physical Therapy # 2
SVCS
PROV2375
04020
Service - Physical Therapy # 3
SVCS
PROV2380
04030
Service - Physicains
SVCS
Provided by Staff and Arrangement
PROV2385
04040
Service - Physicians # 2
SVCS
PROV2390
04050
Service - Physicians # 3
SVCS
PROV2395
04060
Services - Psychological
SVCS
Not Provided
PROV2420
04070
Services - Psychological # 2
SVCS
PROV2425
04080
Services - Psychological # 3
SVCS
PROV2430
04090
Service - Respiratory Care
SVCS
Not Provided
PROV2455
04100
Service - Respiratory Care # 2
SVCS
PROV2460
04110
Service - Respiratory Care # 3
SVCS
PROV2465
04120
Service - Social Services # 2
SVCS
PROV2490
04130
Service - Social Services # 3
SVCS
PROV2495
04140
Service - Speech Pathology # 2
SVCS
PROV2510
04150
Service - Speech Pathology # 2
SVCS
PROV2515
04160
103298
CENTER FOR REHABILITATION OF PALM BEACH, LLC
BOYNTON BEACH, FL 33437
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Outpatient Rehabilation
PROV0075
00020
Change of Ownership Counter
03
PROV0095
00030
Change of Ownership Date
DATE
11/29/2005
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
04/24/2007
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00090
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
07/16/1998
PROV1565
00160
Date of Prior Change in Ownership
DATE
02/15/1999
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
103298
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
5615722237
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
Fiscal Year Ending Month/Day
1231
PROV0485
00570
Service - Occupational Therapy
SVCS
Provided by Staff
PROV2270
01240
Service - Physicial Therapy
SVCS
Provided by Staff
PROV2370
01360
Service - Social Services
SVCS
Provided by Staff and Arrangement
PROV2485
01510
Service - Speech Pathology
SVCS
Not Provided
PROV2505
01520
Related Provider Number
CODE
PROV1755
02560
This Provider participates with Physical Therapy
N
PROV1570
03940
Service - Nursing #2
SVCS
PROV6140
03950
Service - Nursing #3
SVCS
PROV6145
03960
Service - Occupational Physical Therapy # 2
SVCS
PROV2275
03970
Service - Occupatiolnal Physical Therapy # 3
SVCS
PROV2280
03980
Service - Orthotic / Prosthetic # 1
SVCS
Not Provided
PROV2325
03990
Service - Orthotic / Prosthetic # 2
SVCS
PROV2330
04000
Service - Orthotic / Prosthetic # 3
SVCS
PROV2335
04010
Service - Physical Therapy # 2
SVCS
PROV2375
04020
Service - Physical Therapy # 3
SVCS
PROV2380
04030
Service - Physicains
SVCS
Provided under Arrangement
PROV2385
04040
Service - Physicians # 2
SVCS
PROV2390
04050
Service - Physicians # 3
SVCS
PROV2395
04060
Services - Psychological
SVCS
Not Provided
PROV2420
04070
Services - Psychological # 2
SVCS
PROV2425
04080
Services - Psychological # 3
SVCS
PROV2430
04090
Service - Respiratory Care
SVCS
Not Provided
PROV2455
04100
Service - Respiratory Care # 2
SVCS
PROV2460
04110
Service - Respiratory Care # 3
SVCS
PROV2465
04120
Service - Social Services # 2
SVCS
PROV2490
04130
Service - Social Services # 3
SVCS
PROV2495
04140
Service - Speech Pathology # 2
SVCS
PROV2510
04150
Service - Speech Pathology # 2
SVCS
PROV2515
04160
104506
REHAB CTR FOR CHILDREN AND ADU
PALM BEACH, FL 33480
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Outpatient Rehabilation
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
06/29/2004
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00090
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
03/10/1983
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
51100
PROV1620
00180
Provider Number
CODE
104506
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
5616557266
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
Non Profit Other
PROV2885
00310
Provider Zip Code
33480
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
1231
PROV0485
00570
Service - Occupational Therapy
SVCS
Provided by Staff
PROV2270
01240
Service - Physicial Therapy
SVCS
Provided by Staff
PROV2370
01360
Service - Social Services
SVCS
Provided under Arrangement
PROV2485
01510
Service - Speech Pathology
SVCS
Provided by Staff
PROV2505
01520
Related Provider Number
CODE
PROV1755
02560
This Provider participates with Physical Therapy
N
PROV1570
03940
Service - Nursing #2
SVCS
PROV6140
03950
Service - Nursing #3
SVCS
PROV6145
03960
Service - Occupational Physical Therapy # 2
SVCS
PROV2275
03970
Service - Occupatiolnal Physical Therapy # 3
SVCS
PROV2280
03980
Service - Orthotic / Prosthetic # 1
SVCS
Not Provided
PROV2325
03990
Service - Orthotic / Prosthetic # 2
SVCS
PROV2330
04000
Service - Orthotic / Prosthetic # 3
SVCS
PROV2335
04010
Service - Physical Therapy # 2
SVCS
PROV2375
04020
Service - Physical Therapy # 3
SVCS
PROV2380
04030