POS Rural Reference Report
Line
Line Descriptions
Value
Type
POS Field
101800
NORTH PALM BEACH IDC
NORTH PALM BEACH, FL 33408
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Fed Qualified Rural Cntr
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
00450
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
11/08/2006
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
101800
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)
LAN
PROV2710
00250
Provider Telephone Number
5617768300
PROV1605
00270
Termination Reason Code
Active
PROV4770
00280
Termination Date/Expriation Date
DATE
PROV4500
00290
Type of Action for Transmittal
Initial
PROV2880
00300
Type of Control for Provider
Other
PROV2885
00310
Provider Zip Code
33408
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
Other Personnel
FTES
0.00
PROV1075
00640
Physician Assistants
FTES
0.00
PROV1115
00670
Related Provider Number
CODE
PROV1755
02560
Receives Federal Program Support
PROV0480
03890
Nurse Practitioners in Rural Clinic
FTES
0.00
PROV1015
03900
Provider Number of Parent Organization
PROV1560
03910
Physicians Employed by Provider
FTES
0.00
PROV1110
03920
Title of Federal Program providing support
PROV2845
03930
Federally Funded Health Center
Y
PROV3710
04540
FQHC Approved RHC Provider Number
PROV3705
04550
FQHC Approved Rural Health Clinic
N
PROV3700
04560
101801
ECONOMIC OPPORTUNITY FAMILY HLTH CTR
MIAMI, FL 33142
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Fed Qualified Rural Cntr
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
120
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
00450
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
10/01/1991
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
51140
PROV1620
00180
Provider Number
CODE
101801
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)
MIA
PROV2710
00250
Provider Telephone Number
3056376400
PROV1605
00270
Termination Reason Code
Active
PROV4770
00280
Termination Date/Expriation Date
DATE
PROV4500
00290
Type of Action for Transmittal
Initial
PROV2880
00300
Type of Control for Provider
Private
PROV2885
00310
Provider Zip Code
33142
PROV2905
00320
Provider FIPS State
12
FIPSTATE
00330
Provider FIPS County
12025
FIPCNTY
00340
SSA MSA Code
361
SSAMSACD
00350
SSA MSA Size Code
B
SSAMSASZ
00360
Other Personnel
FTES
0.00
PROV1075
00640
Physician Assistants
FTES
0.00
PROV1115
00670
Related Provider Number
CODE
PROV1755
02560
Receives Federal Program Support
PROV0480
03890
Nurse Practitioners in Rural Clinic
FTES
0.00
PROV1015
03900
Provider Number of Parent Organization
PROV1560
03910
Physicians Employed by Provider
FTES
0.00
PROV1110
03920
Title of Federal Program providing support
PROV2845
03930
Federally Funded Health Center
Y
PROV3710
04540
FQHC Approved RHC Provider Number
PROV3705
04550
FQHC Approved Rural Health Clinic
N
PROV3700
04560
101803
BRADENTON FAMILY CHIROPRACTIC
BRADENTON, FL 34204
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Fed Qualified Rural Cntr
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
400
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
00450
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
12/08/2006
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
101803
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)
TAM
PROV2710
00250
Provider Telephone Number
9417584055
PROV1605
00270
Termination Reason Code
Active
PROV4770
00280
Termination Date/Expriation Date
DATE
PROV4500
00290
Type of Action for Transmittal
Initial
PROV2880
00300
Type of Control for Provider
Other
PROV2885
00310
Provider Zip Code
34204
PROV2905
00320
Provider FIPS State
12
FIPSTATE
00330
Provider FIPS County
12081
FIPCNTY
00340
SSA MSA Code
084
SSAMSACD
00350
SSA MSA Size Code
E
SSAMSASZ
00360
Other Personnel
FTES
0.00
PROV1075
00640
Physician Assistants
FTES
0.00
PROV1115
00670
Related Provider Number
CODE
PROV1755
02560
Receives Federal Program Support
PROV0480
03890
Nurse Practitioners in Rural Clinic
FTES
0.00
PROV1015
03900
Provider Number of Parent Organization
PROV1560
03910
Physicians Employed by Provider
FTES
0.00
PROV1110
03920
Title of Federal Program providing support
PROV2845
03930
Federally Funded Health Center
Y
PROV3710
04540
FQHC Approved RHC Provider Number
PROV3705
04550
FQHC Approved Rural Health Clinic
N
PROV3700
04560
101804
ARLINGTON HOUSE ACLF, INC
PALATKA, FL 32177
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Fed Qualified Rural Cntr
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
530
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
00450
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
12/15/2006
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
101804
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)
GAI
PROV2710
00250
Provider Telephone Number
3863280657
PROV1605
00270
Termination Reason Code
Active
PROV4770
00280
Termination Date/Expriation Date
DATE
PROV4500
00290
Type of Action for Transmittal
Initial
PROV2880
00300
Type of Control for Provider
Other
PROV2885
00310
Provider Zip Code
32177
PROV2905
00320
Provider FIPS State
12
FIPSTATE
00330
Provider FIPS County
12107
FIPCNTY
00340
SSA MSA Code
999
SSAMSACD
00350
SSA MSA Size Code
SSAMSASZ
00360
Other Personnel
FTES
0.00
PROV1075
00640
Physician Assistants
FTES
0.00
PROV1115
00670
Related Provider Number
CODE
PROV1755
02560
Receives Federal Program Support
PROV0480
03890
Nurse Practitioners in Rural Clinic
FTES
0.00
PROV1015
03900
Provider Number of Parent Organization
PROV1560
03910
Physicians Employed by Provider
FTES
0.00
PROV1110
03920
Title of Federal Program providing support
PROV2845
03930
Federally Funded Health Center
Y
PROV3710
04540
FQHC Approved RHC Provider Number
PROV3705
04550
FQHC Approved Rural Health Clinic
N
PROV3700
04560
101805
COMMUNITY CARE FAMILY HEALTH CENTER
ARCADIA, FL 34266
A
N
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Fed Qualified Rural Cntr
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
130
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
00450
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
02/22/2007
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
PROV1620
00180
Provider Number
CODE
101805
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)
TAM
PROV2710
00250
Provider Telephone Number
8634916222
PROV1605
00270
Termination Reason Code
Active
PROV4770
00280
Termination Date/Expriation Date
DATE
PROV4500
00290
Type of Action for Transmittal
Initial
PROV2880
00300
Type of Control for Provider
Other
PROV2885
00310
Provider Zip Code
34266
PROV2905
00320
Provider FIPS State
12
FIPSTATE
00330
Provider FIPS County
12027
FIPCNTY
00340
SSA MSA Code
999
SSAMSACD
00350
SSA MSA Size Code
SSAMSASZ
00360
Other Personnel
FTES
0.00
PROV1075
00640
Physician Assistants
FTES
0.00
PROV1115
00670
Related Provider Number
CODE
PROV1755
02560
Receives Federal Program Support
PROV0480
03890
Nurse Practitioners in Rural Clinic
FTES
0.00
PROV1015
03900
Provider Number of Parent Organization
PROV1560
03910
Physicians Employed by Provider
FTES
0.00
PROV1110
03920
Title of Federal Program providing support
PROV2845
03930
Federally Funded Health Center
Y
PROV3710
04540
FQHC Approved RHC Provider Number
PROV3705
04550
FQHC Approved Rural Health Clinic
N
PROV3700
04560
101819
FLORIDA DEPARTMENT OF HEALTH
WEST PALM BEACH, FL 33407
A
Subtype of provider
Short Term
PROV0085
00010
Category of Provider/Supplier
Fed Qualified Rural Cntr
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
00450
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
08/11/1992
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
51140
PROV1620
00180
Provider Number
CODE
101819
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)
LAN
PROV2710