POS SNF Reference Report
Line
Line Descriptions
Value
Type
POS Field
105039
REHAB CTR OF THE PALM BEACHES
WEST PALM BEACH, FL 33407
A
Subtype of provider
Religious NonMedical Facility
PROV0085
00010
Category of Provider/Supplier
SNF/NF (Distinct)
PROV0075
00020
Change of Ownership Counter
01
PROV0095
00030
Change of Ownership Date
DATE
07/01/2003
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
02/10/2005
PROV0500
00100
Official Survey Date
DATE
05/02/2007
PROV2740
00110
Eligibility for Medicare/Mediciad
Yes
PROV0455
00120
Intermediary/Carrier Servicing Provider
00363
PROV0605
00140
Medicare/Medicaid Vendor Number
CODE
026391500
PROV0655
00150
Date Approved for Medicare/Medicaid
DATE
01/01/1967
PROV1565
00160
Date of Prior Change in Ownership
DATE
PROV1615
00170
Prior Intermediary Number
CODE
52280
PROV1620
00180
Provider Number
CODE
105039
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
5617121717
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 - Corporation
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
Beds - Total
BEDS
99
PROV0740
00400
Beds - Total Certified
BEDS
99
PROV0755
00410
Compliance - Life Safety Code
CMPL
PROV0240
00480
Compliance - Technical Personnel
CMPL
PROV0285
00500
Fiscal Year Ending Month/Day
0630
PROV0485
00570
Program Participation - Medicare/Medicaid
Medicare and Medicaid
PROV1670
00680
Region Override #1 for Number of Beds
PROV1545
00760
Region Override #2 for Staffing
PROV1550
00770
Activity Professional - Contract
FTES
0.00
PROV0695
01610
Activity Professional - Full Time
FTES
1.14
PROV0700
01620
Activity Professional - Part Time
FTES
0.00
PROV0705
01630
Administration - Contract
FTES
0.00
PROV0710
01640
Administrator - Full Time
FTES
1.14
PROV0715
01650
Administrator - Part Time
FTES
0.00
PROV0720
01660
Beds - Medicare SNF
BEDS
4
PROV1445
01670
Beds - Nursing Facility
BEDS
0
PROV1455
01680
Beds - SNF/NF
BEDS
95
PROV1450
01690
Certified Nurse Aids - Contract
FTES
0.00
PROV1000
01700
Certified Nurse Aids - Full Time
FTES
52.91
PROV1005
01710
Certified Nurse Aids - Part Time
FTES
1.64
PROV1010
01720
Christian Science Indicator
PROV0110
01730
Waiver of beds per room requirement recommended
PROV0225
01740
Waiver of patient room size recommended
PROV0270
01750
Waiver of 7 day registered nurse recommended
PROV0295
01760
Dentists - Contract
FTES
0.03
PROV0785
01770
Dentists - Full Time
FTES
0.00
PROV0790
01780
Dentists - Part Time
FTES
0.00
PROV0795
01790
Dietitians - Contract
FTES
0.00
PROV0805
01800
Dietitians - Full Time
FTES
0.00
PROV0810
01810
Dietitians - Part Time
FTES
0.23
PROV0815
01820
Facility uses residents for clinical trials
PROV0465
01830
Food Service - Contract
FTES
0.00
PROV0860
01840
Food Service - Full Time
FTES
8.24
PROV0865
01850
Food Service - Part Time
FTES
1.27
PROV0870
01860
Housekeeping - Contract
FTES
9.14
PROV0925
01870
Housekeeping - Full Time
FTES
0.00
PROV0930
01880
Housekeeping - Part Time
FTES
0.00
PROV0935
01890
LPN/LVN - Contract
FTES
0.00
PROV1465
01900
LPN/LVN - Full Time
FTES
14.17
PROV1470
01910
LPN/LVN - Part Time
FTES
0.00
PROV1475
01920
Long Term Care cross reference provider number
PROV0640
01930
Medical Director - Contract
FTES
0.09
PROV0960
01940
Medical Director - Full Time
FTES
0.00
PROV0965
01950
Medical Director - Part Time
FTES
0.00
PROV0970
01960
Medication Aides/Techs - Contract
FTES
0.00
PROV5180
01970
Medication Aides/Techs - Full Time
FTES
0.00
PROV5170
01980
Medication Aides/Techs - Part Time
FTES
0.00
PROV5175
01990
Mental Health Services - Contract
FTES
0.09
PROV0980
02000
Mental Health Services - Full Time
FTES
0.00
PROV0985
02010
Mental Health Services - Part Time
FTES
0.00
PROV0990
02020
Facility owned by Organization with over 2 facilit
Y
PROV0675
02040
Nurse Aides in Training - Contract
FTES
0.00
PROV5165
02050
Nurse Aides in Training - Full Time
FTES
0.00
PROV5155
02060
Nurse Aides in Training - Part Time
FTES
0.00
PROV5160
02070
Nurses with Administrative Duties - Contract
FTES
0.00
PROV5150
02080
Nurses with Administrative Duties - Full Time
FTES
2.29
PROV5135
02090
Nurses with Administrative Duties - Part Time
FTES
0.00
PROV5145
02100
Occupational Therapy Aide - Contract
FTES
0.00
PROV1020
02110
Occupational Therapist - Full Time
FTES
1.00
PROV1040
02120
Occupational Therapist - Part time
FTES
0.00
PROV1045
02130
Occupational Therapy Aide - Full Time
FTES
0.00
PROV1025
02140
Occupational Therapy Aide - Part Time
FTES
0.00
PROV1030
02150
Occupational Therapy Assistant - Contract
FTES
1.43
PROV5195
02160
Occupational Therapy Assistant - Contract
FTES
0.00
PROV5185
02170
Occupational Therapy Assistant - Contract
FTES
0.00
PROV5190
02180
Occupational Therapist - Contract
FTES
0.00
PROV1035
02190
Facility has an organized Group of Family Members
Y
PROV1535
02200
Facility has organized residents group
Y
PROV1540
02210
Other personnell - Contract
FTES
0.00
PROV3265
02220
Other personnell - Full Time
FTES
0.00
PROV3245
02230
Other personnell - Part Time
FTES
0.00
PROV3255
02240
Other Activities Staff - Contract
FTES
0.00
PROV5270
02250
Other Activities Staff - Full Time
FTES
0.00
PROV5260
02260
Other Activities Staff - Part Time
FTES
0.00
PROV5305
02270
Other Physicians - Contract
FTES
0.00
PROV1060
02280
Other Physicians - Full Time
FTES
0.00
PROV1065
02290
Other Physicians - Part Time
FTES
0.00
PROV1070
02300
Other Social Service Staff - Contract
FTES
0.00
PROV5300
02310
Other Social Service Staff - Full Time
FTES
0.00
PROV5290
02320
Other Social Service Staff - Part Time
FTES
0.00
PROV5295
02330
Pharmacists - Contract
FTES
0.03
PROV1085
02340
Pharmacists - Full Time
FTES
0.00
PROV1090
02350
Pharmacists - Part Time
FTES
0.00
PROV1095
02360
Physicial Therapist Assistant - Contract
FTES
0.43
PROV5210
02370
Physicial Therapist Assistant - Full Time
FTES
0.00
PROV5200
02380
Physicial Therapist Assistant - Part Time
FTES
0.00
PROV5205
02390
Physicial Therapist - Contract
FTES
1.00
PROV1430
02400
Physicial Therapist - Full Time
FTES
0.00
PROV1435
02410
Physicial Therapist - Part Time
FTES
0.00
PROV1440
02420
Physicial Therapy Aide - Contract
FTES
0.00
PROV1415
02430
Physicial Therapy Aide - Full Time
FTES
0.00
PROV1420
02440
Physicial Therapy Aide - Part Time
FTES
0.00
PROV1425
02450
Physician Extender - Contract
FTES
0.00
PROV3270
02460
Physician Extender - Full Time
FTES
0.00
PROV3250
02470
Physician Extender - Part Time
FTES
0.00
PROV3260
02480
Prodiatrists - Contract
FTES
0.06
PROV1130
02490
Prodiatrists - Full Time
FTES
0.00
PROV1135
02500
Prodiatrists - Part Time
FTES
0.00
PROV1140
02510
Long Term Facility is hospital based
PROV1675
02520
Registered Nurse - Contract
FTES
0.00
PROV1150
02530
Registered Nurse - Full Time
FTES
3.10
PROV1155
02540
Registered Nurse - Part Time
FTES
1.43
PROV1160
02550
Related Provider Number
CODE
PROV1755
02560
Date that payment suspension was recinded
DATE
PROV1825
02570
RN Director of Nursing - Contract
FTES
0.00
PROV5130
02580
RN Director of Nursing - Full Time
FTES
1.14
PROV5120
02590
RN Director of Nursing - Part Time
FTES
0.00
PROV5140
02600
Social Worker - Contract
FTES
0.00
PROV1170
02610
Social Worker - Full Time
FTES
1.14
PROV1175
02620
Social Worker - Part Time
FTES
0.00
PROV1180
02630
Special Care Beds - AIDS
BEDS
000
PROV0725
02640
Speech Pathologist - Part Time
FTES
0.00
PROV1200
02750
Special Activities provided offsite
SVCS
N
PROV3390
02760
Activities provided to non-residents
SVCS
N
PROV3385
02770
Activities provider to residents
SVCS
Y
PROV3380
02780
Blood Administration provided offsite to residents
SVCS
N
PROV3525
02790
Blood Administration provided onsite to non-res
SVCS
N
PROV3520
02800
Blood Administration provided onsite to residents
SVCS
N
PROV3515
02810
Clinical Lab provided offsite to residents
SVCS
N
PROV3495
02820
Clinical Lab provided onsite to non residents
SVCS
N
PROV3490
02830
Clinical Lab provided onsite to residents
SVCS
Y
PROV3485
02840
Dental Services provided offsite to residents
SVCS
N
PROV3435
02850
Dental Services provided onsite to non residents
SVCS
N
PROV3430
02860
Dental Services provided onsite to residents
SVCS
Y
PROV3425
02870
Dietary Services provided offsite to residents
SVCS
N
PROV3345
02880
Dietary Services provided onsite to non residents
SVCS
N
PROV3340
02890
Dietary Services provided onsite to residents
SVCS
Y
PROV3335
02900
Housekeeping provided onsite to non residents
SVCS
N
PROV3535
02910
Housekeeping provided offsite to residents
SVCS
N
PROV3540
02920
Housekeeping provided onsite to residents
SVCS
Y
PROV3530
02930
Mental Health provided offsite to residents
SVCS
N
PROV3465
02940
Mental Health provided onsite to non residents
SVCS
N
PROV3460
02950
Mental Health provided onsite to residents
SVCS
Y
PROV3455
02960
Nursing Services provided offsite to residents
SVCS
N
PROV3315
02970
Nursing Services provided onsite to non residents
SVCS
N
PROV3310
02980
Nursing Services provided onsite to residents
SVCS
Y
PROV3305
02990
Occupational Therapy provided offsite to residents
SVCS
N
PROV3360
03000
Occupational Therapy provided onsite to non-res
SVCS
Y
PROV3355
03010
Occupational Therapy provided onsite to residents
SVCS
Y
PROV3350
03020
Other Activities provided offsite to residents
SVCS
N
PROV5255
03030
Other Activities provided onsite to non residents
SVCS
N
PROV5250
03040
Other Activities provided onsite to non residents
SVCS
N
PROV5245
03050
Other Social Svcs provided offsite to residents
SVCS
N
PROV5285
03060
Other Social Svcs provided onsite to non resident
SVCS
N
PROV5280
03070
Other Social Svcs provided onsite to residents
SVCS
N
PROV5275
03080
Pharmacy Svcs provided offsite to residents
SVCS
N
PROV3330
03090
Pharmacy Svcs provided onsite to non residents
SVCS
N
PROV3325
03100
Pharmacy Svcs provided onsite to residents
SVCS
Y
PROV3320
03110
Physician Extender provided offisite to residents
SVCS
N
PROV3300
03120
Physician Extender provided onsite to non-res
SVCS
N
PROV3295
03130
Physician Extender provided onisite to residents
SVCS
N
PROV3290
03140
Physicial Therapy provided offsite to residents
SVCS
N
PROV3375
03150
Physicial Therapy provided onsite to non residents
SVCS
Y
PROV3370
03160
Physicial Therapy provided onsite to residents
SVCS
Y
PROV3365
03170
Physician Services provided offsite to residents
SVCS
N
PROV3285
03180
Physician Services provided onsite to non resident
SVCS
N
PROV3280
03190
Physician Services provided onsite to residents
SVCS
Y
PROV3275
03200
Podiatry Services provided offsite to residents
SVCS
N
PROV3450
03210
Podiatry Services provided onsite to non residents
SVCS
N
PROV3445
03220
Podiatry Services provided onsite to residents
SVCS
Y
PROV3440
03230
Social Work Svcs provided offsite to residents
SVCS
N
PROV3405
03240
Social Work Svcs provided onsite to non residents
SVCS
N
PROV3400
03250
Social Work Svcs provided onsite to residents
SVCS
Y
PROV3395
03260
Speech Pathology provided offsite to residents
SVCS
N
PROV3420
03270
Speech Pathology provided onsite to non residents
SVCS
Y
PROV3415
03280
Speech Pathology provided onsite to residents
SVCS
Y
PROV3410
03290
Therapeutic Recrecation provided offsite to reside
SVCS
N
PROV5225
03300
Therapeutic Recrecation provided onsite to non-res
SVCS
N
PROV5220
03310
Therapeutic Recrecation provided onsite to residen
SVCS
N
PROV5215
03320
Vocational Services provided offsite to residents
SVCS
N
PROV3480
03330
Vocational Services provided onsite to non residen
SVCS
N
PROV3475
03340
Vocational Services provided onsite to residents
SVCS
N
PROV3470
03350
XRay Diag Services provided offsite to residents
SVCS
N
PROV3510
03360
XRay Diag Services provided onsite to non resident
SVCS
N
PROV3505
03370
XRay Diag Services provided onsite to residents
SVCS
Y
PROV3500
03380
Therapeutic Recreation Specialist - Contract
FTES
0.00
PROV5240
03390
Therapeutic Recreation Specialist - Contract
FTES
0.00
PROV5230
03400