rpt pos reference

104008

THE JEROME GOLDEN CENTER FOR BEHAVIORAL HEALTH, IN

WEST PALM BEACH, FL 33407

00320 FIPS County Code 12099 FIPCNTY

00310 FIPS State Code 12 FIPSTATE

00280 Type of Action Code 8 PR201301

00370 Affiliated Resident Program: Allopathic N PR201302

00380 Affiliated Resident Program: Dental N PR201303

00390 Affiliated Resident Program: Osteopathic N PR201304

00400 Affiliated Resident Program: Other N PR201305

01380 Services: Cardiac Catheterization Lab Code 0 PR201314

00340 Accreditation Effective Date 07/19/2011 DATE PROV0000

00350 Accreditation Expiration Date 07/18/2014 DATE PROV0005

00360 Accreditation Type Code JCAHO PROV0010

00020 Provider Category Code Hospital PROV0075

00010 Provider Category Subtype Code Psychiatric PROV0085

00030 Change of Ownership Count 1 PROV0095

00040 Change of Ownership Date DATE PROV0100

00060 Compliance: Plan of Correction N PROV0220

00750 Compliance: Life Safety Code N CMPL PROV0240

00770 Compliance: Scope of Service N CMPL PROV0280

00780 Compliance: Technical Personnel Waiver N CMPL PROV0285

00720 Compliance: 24 Hour Registered Nurse N CMPL PROV0290

00090 Cross Ref Provider Number CODE PROV0300

04850 Date of Validation Survey DATE PROV0450

00110 Eligibility Switch Yes PROV0455

00850 Fiscal Year Ending Date 0930 PROV0485

00100 Certification Date 08/13/2009 DATE PROV0500

00130 Intermediary Carrier Code 52280 PROV0605

00930 Medical School Affiliation No Affiliation PROV0645

00140 Medicare or Medicaid Vendor Number CODE PROV0655

00990 Meets 1861 Definition N CMPL PROV0670

01000 Type of Non-Participating Provider PROV0690

00630 Beds-Total 44 BEDS PROV0740

00490 Beds - Total Certified 44 BEDS PROV0755

03490 Certified Registered Nurse Anesthetists (CRNA) 0 FTES PROV0760

03530 Dietitians 0 FTES PROV0820

04460 Respiratory Therapists 0 FTES PROV0950

03670 Licensed Practical/Vocational Nurses 3 FTES PROV0955

03750 Medical Social Workers 3 FTES PROV0975

4:45 PM

www.Halmanac.com

Healthcare Almanac 561-594-7551

7/29/2015

All Providers

POS Hospital Reference Report

Line Line Description TypeValue Field Name

http://www.halmanac.com/

03880 Nurse Practitioners 0 FTES PROV1015

03920 Occupational Therapists 0 FTES PROV1050

03430 Other Personnel 0 FTES PROV1075

04450 Registered Pharmacists 1 FTES PROV1100

04210 Physicians 5 FTES PROV1110

04330 Physical Therapists 0 FTES PROV1125

04470 Registered Nurses 20 FTES PROV1145

04270 Physicians (Residents) 0 FTES PROV1165

04640 Speech Pathologist or Audiologist 0 FTES PROV1220

00480 Regional Override # 1 (Number Beds) No PROV1545

03380 Regional Override # 2 (Staffing) No PROV1550

01010 Regional Override # 3 (Nurse - Bed) No PROV1555

00150 Participation Date 09/01/1970 DATE PROV1565

01080 Program Participation 1 PROV1570

00250 Telephone Number 5618449741 PROV1605

00160 Prior Change of Ownership Date DATE PROV1615

00170 Intermediary Carrier Prior Code 52280 CODE PROV1620

00950 Medicare or Medicaid Participating Provider Switch Y PROV1670

00180 Provider Number 104008 CODE PROV1680

01100 Psychiatric Unit Bed Count 0 BEDS PROV1690

01110 Psychiatric Unit Effective Date DATE PROV1695

01120 Psychiatric Unit Switch No PROV1700

01130 Psychiatric Unit Termination Code PROV1705

01140 Psychiatric Unit Termination Date DATE PROV1710

00190 Region Code Atlanta PROV1725

01150 Rehabilitation Unit Bed Count 0 BEDS PROV1730

01160 Rehabilitation Unit Effective Date DATE PROV1735

01170 Rehabilitation Unit Switch No PROV1740

01180 Rehabilitation Unit Termination Code PROV1745

01190 Rehabilitation Unit Termination Date DATE PROV1750

01200 Related Provider Number CODE PROV1755

00200 Skeleton Record Switch N PROV2045

01210 Services Provided: Acute Renal Dialysis Not Provided SVCS PROV2055

01260 Services Provided: Alcohol and/or Drug Not Provided SVCS PROV2065

01280 Services Provided: Anesthesia Not Provided SVCS PROV2070

01360 Services Provided: Burn Care Unit Not Provided SVCS PROV2090

01460 Services Provided: Chiropractic Not Provided SVCS PROV2100

01530 Services Provided: ICU Cardiac (non-surgical) Not Provided SVCS PROV2110

01580 Services Provided: Dental Not Provided SVCS PROV2120

01670 Services Provided: Dietary Provided by Staff SVCS PROV2130

01930 Services Provided: ICU Medical/Surgical Not Provided SVCS PROV2185

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7/29/2015

All Providers




01880 Services Provided: Inpatient Surgical Not Provided SVCS PROV2190

01510 Services Provided: Clinical Laboratory 2 SVCS PROV2200

02040 Services Provided: Neonatal Nursery Not Provided SVCS PROV2235

02100 Services Provided: Nuclear Medicine Not Provided SVCS PROV2245

02200 Services Provided: Obstetrics Not Provided SVCS PROV2265

02360 Services Provided: Occupational Therapy Not Provided SVCS PROV2270

01400 Services Provided: Cardiac - Thoracic Surgery Not Provided SVCS PROV2285

02240 Services Provided: Optometric Not Provided SVCS PROV2295

02260 Services Provided: Operating Rooms Not Provided SVCS PROV2300

02080 Services Provided: Organ Transplant (Not Medicare Not Provided SVCS PROV2315

02420 Services Provided: Outpatient Provided by Staff SVCS PROV2350

02480 Services Provided: Outpatient Surgery Not Provided SVCS PROV2355

02500 Services Provided: Pediatric Not Provided SVCS PROV2360

00430 Services Provided: Pharmacy Provided by Staff SVCS PROV2365

02820 Services Provided: Physical Therapy Not Provided SVCS PROV2370

02720 Services Provided: Postoperative Recovery Room Not Provided SVCS PROV2410

01230 Services Provided: Psychiatric - Adult Inpatient Provided by Staff SVCS PROV2415

01650 Services Provided: Radiology (Diagnostic) Not Provided SVCS PROV2440

03230 Services Provided: Radiology (Therapeutic) Not Provided SVCS PROV2445

02920 Services Provided: Respiratory Care Not Provided SVCS PROV2455

01630 Services Provided: Trauma Center (Designated) Not Provided SVCS PROV2475

02980 Services Provided: Social Provided by Staff SVCS PROV2485

03060 Services Provided: Speech Pathology Not Provided SVCS PROV2505

00080 SSA County Code 490 PROV2695

00220 SSA State Code 10 PROV2700

00230 State Region Code LAN PROV2710

00070 Compliance: Status Not In Compliance PROV2715

04790 Swing Bed Switch Swing Bed service not approved PROV2795

04800 Swing Bed Size Code PROV2800

00290 General Type of Control Code Voluntary Non-Profit - Private PROV2885

00410 Type of Facility Psychiatric PROV2890

00300 ZIP Code 33407 PROV2905

00210 State Abbreviation FL PROV3230

00790 Current Survey Ever Swing Bed No PROV3550

00270 Termination Date / Expiration Date 1 DATE PROV4500

00260 Termination Code 1 Active PROV4770

01310 Services Provided: Audiology Not Provided SVCS PROV6160

01440 Services Provided: Chemotherapy Not Provided SVCS PROV6170

01560 Services Provided: CT Scanner Not Provided SVCS PROV6175

01720 Services Provided: Emergency Dept(Dedicated) Not Provided SVCS PROV6180

01760 Services Provided: Extracorporeal Shock Wave Not Provided SVCS PROV6185

4:45 PM

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7/29/2015

All Providers




01820 Services Provided: Gerontological Specialty Not Provided SVCS PROV6190

02020 Services Provided: ICU Neonatal Not Provided SVCS PROV6195

02520 Services Provided: ICU Pediatric Not Provided SVCS PROV6200

03120 Services Provided: ICU Surgical Not Provided SVCS PROV6205

02000 Services Provided: Magnetic Resonance Imaging Not Provided SVCS PROV6210

02060 Services Provided: Neurosurgical Services Not Provided SVCS PROV6215

02220 Services Provided: Ophthalmic Surgery Not Provided SVCS PROV6220

02280 Services Provided: Orthopedic Surgery Not Provided SVCS PROV6225

02540 Services Provided: PET Scan Services Not Provided SVCS PROV6230

01740 Services Provided: Psychiatric - Emergency Provided by Staff SVCS PROV6235

02740 Services Provided: Psychiatric Child/Adolescent Not Provided SVCS PROV6240

01780 Services Provided: Psychiatric - Forensic Not Provided SVCS PROV6245

01800 Services Provided: Psychiatric - Geriatric Not Provided SVCS PROV6250

02440 Services Provided: Psychiatric - Outpatient Provided by Staff SVCS PROV6255

02870 Services Provided: Reconstructive Surgery Not Provided SVCS PROV6260

02460 Services Provided: Rehabilitation Outpatient Not Provided SVCS PROV6265

01420 Services Provided: CARF Inpatient Rehabilitation C Not Provided SVCS PROV6270

01950 Services Provided: Transplant Center (Medicare Cer Not Provided SVCS PROV6275

03280 Services Provided: Urgent Care Center Services Not Provided SVCS PROV6280

03770 Medical Technologist Count 0 FTES PROV6290

03840 Nuclear Medicine Technician Count 0 FTES PROV6295

04310 Psychologist Count 0 FTES PROV6300

04440 Radiology Technician Count 0 FTES PROV6305

00840 Fax Phone Number PROV9015

04230 Physician Assistants (PA) 0 PROV9020

00330 CBSA Urban Rural Indicator U SSAMSASZ

104011

LAKE HOSP OF THE PALM BEACHES

LAKE WORTH, FL 33460












4:45 PM

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7/29/2015

All Providers














04850 Date of Validation Survey 01/07/1992 DATE PROV0450

00110 Eligibility Switch No PROV0455

























03380 Regional Override # 2 (Staffing) Yes PROV1550





4:45 PM

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7/29/2015

All Providers





00170 Intermediary Carrier Prior Code CODE PROV1620






























02360 Services Provided: Occupational Therapy Provided by Staff and Arrangement

SVCS PROV2270





02420 Services Provided: Outpatient Not Provided SVCS PROV2350



00430 Services Provided: Pharmacy Provided under Arrangement SVCS PROV2365

4:45 PM

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7/29/2015

All Providers




02820 Services Provided: Physical Therapy Provided under Arrangement SVCS PROV2370



01650 Services Provided: Radiology (Diagnostic) Provided by Staff and Arrangement

SVCS PROV2440





03060 Services Provided: Speech Pathology Provided under Arrangement SVCS PROV2505




00070 Compliance: Status In Compliance PROV2715





00300 ZIP Code 33460 PROV2905



00270 Termination Date / Expiration Date 1 05/31/1992 DATE PROV4500

00260 Termination Code 1 Voluntary - Merge,Close PROV4770




01720 Services Provided: Emergency Dept(Dedicated) Provided under Arrangement SVCS PROV6180











01740 Services Provided: Psychiatric - Emergency Not Provided SVCS PROV6235




4:45 PM

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7/29/2015

All Providers




02440 Services Provided: Psychiatric - Outpatient Not Provided SVCS PROV6255













103030

PINECREST REHABILITATION HOSPITAL

DELRAY BEACH, FL 33484













00010 Provider Category Subtype Code Rehabilitation PROV0085












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7/29/2015

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4:45 PM

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7/29/2015

All Providers










01280 Services Provided: Anesthesia Provided under Arrangement SVCS PROV2070



01530 Services Provided: ICU Cardiac (non-surgical) Provided under Arrangement SVCS PROV2110



01930 Services Provided: ICU Medical/Surgical Provided under Arrangement SVCS PROV2185

01880 Services Provided: Inpatient Surgical Provided under Arrangement SVCS PROV2190



02100 Services Provided: Nuclear Medicine Provided under Arrangement SVCS PROV2245

02200 Services Provided: Obstetrics Provided under Arrangement SVCS PROV2265

02360 Services Provided: Occupational Therapy Provided by Staff SVCS PROV2270



02260 Services Provided: Operating Rooms Provided under Arrangement SVCS PROV2300



02480 Services Provided: Outpatient Surgery Provided under Arrangement SVCS PROV2355



02820 Services Provided: Physical Therapy Provided by Staff SVCS PROV2370

02720 Services Provided: Postoperative Recovery Room Provided under Arrangement SVCS PROV2410

01230 Services Provided: Psychiatric - Adult Inpatient Not Provided SVCS PROV2415

01650 Services Provided: Radiology (Diagnostic) Provided under Arrangement SVCS PROV2440

03230 Services Provided: Radiology (Therapeutic) Provided under Arrangement SVCS PROV2445

02920 Services Provided: Respiratory Care Provided under Arrangement SVCS PROV2455



03060 Services Provided: Speech Pathology Provided by Staff SVCS PROV2505






4:45 PM

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7/29/2015

All Providers





00290 General Type of Control Code Proprietary PROV2885

00410 Type of Facility Rehabilitation PROV2890

00300 ZIP Code 33484 PROV2905




































4:45 PM

www.Halmanac.com


7/29/2015

All Providers




102025

KINDRED HOSPITAL THE PALM BEACHES

RIVIERA BEACH, FL 33418













00010 Provider Category Subtype Code Long Term PROV0085

























4:45 PM

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7/29/2015

All Providers













00480 Regional Override # 1 (Number Beds) Yes PROV1545























01210 Services Provided: Acute Renal Dialysis Provided by Staff and Arrangement

SVCS PROV2055


01280 Services Provided: Anesthesia Provided by Staff and Arrangement

SVCS PROV2070



01530 Services Provided: ICU Cardiac (non-surgical) Provided by Staff and Arrangement

SVCS PROV2110


4:45 PM

www.Halmanac.com


7/29/2015

All Providers




01670 Services Provided: Dietary Provided by Staff and Arrangement

SVCS PROV2130

01930 Services Provided: ICU Medical/Surgical Provided by Staff and Arrangement

SVCS PROV2185

01880 Services Provided: Inpatient Surgical Provided by Staff and Arrangement

SVCS PROV2190






SVCS PROV2270



02260 Services Provided: Operating Rooms Provided by Staff and Arrangement

SVCS PROV2300





00430 Services Provided: Pharmacy Provided by Staff and Arrangement

SVCS PROV2365


02720 Services Provided: Postoperative Recovery Room Provided by Staff and Arrangement

SVCS PROV2410



SVCS PROV2440


02920 Services Provided: Respiratory Care Provided by Staff and Arrangement

SVCS PROV2455


02980 Services Provided: Social Provided by Staff and Arrangement

SVCS PROV2485

03060 Services Provided: Speech Pathology Provided by Staff and Arrangement

SVCS PROV2505








00410 Type of Facility Long - Term PROV2890

00300 ZIP Code 33418 PROV2905

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7/29/2015

All Providers










01560 Services Provided: CT Scanner Provided by Staff and Arrangement

SVCS PROV6175



















01420 Services Provided: CARF Inpatient Rehabilitation C Provided by Staff and Arrangement

SVCS PROV6270







00840 Fax Phone Number 5618420271 PROV9015



102023

SELECT SPECIALTY HOSPITAL-PALM BEACH



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7/29/2015

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00090 Cross Ref Provider Number 100309 CODE PROV0300






















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7/29/2015

All Providers






































01670 Services Provided: Dietary Not Provided SVCS PROV2130

01930 Services Provided: ICU Medical/Surgical Provided by Staff SVCS PROV2185

01880 Services Provided: Inpatient Surgical Provided by Staff SVCS PROV2190





4:45 PM

www.Halmanac.com


7/29/2015

All Providers





SVCS PROV2270









SVCS PROV2365

02820 Services Provided: Physical Therapy Provided by Staff and Arrangement

SVCS PROV2370




SVCS PROV2440


02920 Services Provided: Respiratory Care Provided by Staff SVCS PROV2455


02980 Services Provided: Social Not Provided SVCS PROV2485


SVCS PROV2505



00230 State Region Code LAU PROV2710






00300 ZIP Code 33461 PROV2905







01560 Services Provided: CT Scanner Provided by Staff SVCS PROV6175





4:45 PM

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7/29/2015

All Providers






02000 Services Provided: Magnetic Resonance Imaging Provided under Arrangement SVCS PROV6210






















102000

A G HOLLEY STATE HOSPITAL

LANTANA, FL 33465









00340 Accreditation Effective Date DATE PROV0000

00350 Accreditation Expiration Date DATE PROV0005

00360 Accreditation Type Code None PROV0010



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7/29/2015

All Providers

















00930 Medical School Affiliation Limited PROV0645

00140 Medicare or Medicaid Vendor Number 010261000 CODE PROV0655



























4:45 PM

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7/29/2015

All Providers

























01580 Services Provided: Dental Provided under Arrangement SVCS PROV2120















02500 Services Provided: Pediatric Provided by Staff and Arrangement

SVCS PROV2360

00430 Services Provided: Pharmacy Not Provided SVCS PROV2365



4:45 PM

www.Halmanac.com


7/29/2015

All Providers







02920 Services Provided: Respiratory Care Provided by Staff and Arrangement

SVCS PROV2455








04790 Swing Bed Switch Swing Bed service is approved PROV2795

04800 Swing Bed Size Code 49 or fewer swing beds PROV2800

00290 General Type of Control Code Government - State PROV2885


00300 ZIP Code 33465 PROV2905


00790 Current Survey Ever Swing Bed Yes PROV3550























4:45 PM

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7/29/2015

All Providers















10065F

WEST PALM BEACH VA MEDICAL CENTER









01380 Services: Cardiac Catheterization Lab Code PR201314





00010 Provider Category Subtype Code PROV0085











00850 Fiscal Year Ending Date PROV0485



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7/29/2015

All Providers




00930 Medical School Affiliation PROV0645



01000 Type of Non-Participating Provider Emergency Hospital - Federal PROV0690





















01080 Program Participation PROV1570




00950 Medicare or Medicaid Participating Provider Switch N PROV1670

00180 Provider Number 10065F CODE PROV1680












4:45 PM

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7/29/2015

All Providers





00200 Skeleton Record Switch Skeleton record with limited data PROV2045

01210 Services Provided: Acute Renal Dialysis SVCS PROV2055

01260 Services Provided: Alcohol and/or Drug SVCS PROV2065

01280 Services Provided: Anesthesia SVCS PROV2070

01360 Services Provided: Burn Care Unit SVCS PROV2090

01460 Services Provided: Chiropractic SVCS PROV2100

01530 Services Provided: ICU Cardiac (non-surgical) SVCS PROV2110

01580 Services Provided: Dental SVCS PROV2120

01670 Services Provided: Dietary SVCS PROV2130

01930 Services Provided: ICU Medical/Surgical SVCS PROV2185

01880 Services Provided: Inpatient Surgical SVCS PROV2190

01510 Services Provided: Clinical Laboratory SVCS PROV2200

02040 Services Provided: Neonatal Nursery SVCS PROV2235

02100 Services Provided: Nuclear Medicine SVCS PROV2245

02200 Services Provided: Obstetrics SVCS PROV2265

02360 Services Provided: Occupational Therapy SVCS PROV2270

01400 Services Provided: Cardiac - Thoracic Surgery SVCS PROV2285

02240 Services Provided: Optometric SVCS PROV2295

02260 Services Provided: Operating Rooms SVCS PROV2300

02080 Services Provided: Organ Transplant (Not Medicare SVCS PROV2315

02420 Services Provided: Outpatient SVCS PROV2350

02480 Services Provided: Outpatient Surgery SVCS PROV2355

02500 Services Provided: Pediatric SVCS PROV2360

00430 Services Provided: Pharmacy SVCS PROV2365

02820 Services Provided: Physical Therapy SVCS PROV2370

02720 Services Provided: Postoperative Recovery Room SVCS PROV2410

01230 Services Provided: Psychiatric - Adult Inpatient SVCS PROV2415

01650 Services Provided: Radiology (Diagnostic) SVCS PROV2440

03230 Services Provided: Radiology (Therapeutic) SVCS PROV2445

02920 Services Provided: Respiratory Care SVCS PROV2455

01630 Services Provided: Trauma Center (Designated) SVCS PROV2475

02980 Services Provided: Social SVCS PROV2485

03060 Services Provided: Speech Pathology SVCS PROV2505




00070 Compliance: Status PROV2715



00290 General Type of Control Code Not Provider by Hospital PROV2885

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7/29/2015

All Providers




00410 Type of Facility 01 PROV2890

00300 ZIP Code 33410 PROV2905





01310 Services Provided: Audiology SVCS PROV6160

01440 Services Provided: Chemotherapy SVCS PROV6170

01560 Services Provided: CT Scanner SVCS PROV6175

01720 Services Provided: Emergency Dept(Dedicated) SVCS PROV6180

01760 Services Provided: Extracorporeal Shock Wave SVCS PROV6185

01820 Services Provided: Gerontological Specialty SVCS PROV6190

02020 Services Provided: ICU Neonatal SVCS PROV6195

02520 Services Provided: ICU Pediatric SVCS PROV6200

03120 Services Provided: ICU Surgical SVCS PROV6205

02000 Services Provided: Magnetic Resonance Imaging SVCS PROV6210

02060 Services Provided: Neurosurgical Services SVCS PROV6215

02220 Services Provided: Ophthalmic Surgery SVCS PROV6220

02280 Services Provided: Orthopedic Surgery SVCS PROV6225

02540 Services Provided: PET Scan Services SVCS PROV6230

01740 Services Provided: Psychiatric - Emergency SVCS PROV6235

02740 Services Provided: Psychiatric Child/Adolescent SVCS PROV6240

01780 Services Provided: Psychiatric - Forensic SVCS PROV6245

01800 Services Provided: Psychiatric - Geriatric SVCS PROV6250

02440 Services Provided: Psychiatric - Outpatient SVCS PROV6255

02870 Services Provided: Reconstructive Surgery SVCS PROV6260

02460 Services Provided: Rehabilitation Outpatient SVCS PROV6265

01420 Services Provided: CARF Inpatient Rehabilitation C SVCS PROV6270

01950 Services Provided: Transplant Center (Medicare Cer SVCS PROV6275

03280 Services Provided: Urgent Care Center Services SVCS PROV6280








4:45 PM

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7/29/2015

All Providers




100310

KINDRED HOSPITAL THE PALM BEACHES

RIVIERA BEACH, FL 33418













00010 Provider Category Subtype Code Short Term PROV0085



00060 Compliance: Plan of Correction Y PROV0220





00090 Cross Ref Provider Number 102025 CODE PROV0300

















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01210 Services Provided: Acute Renal Dialysis Provided under Arrangement SVCS PROV2055









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7/29/2015

All Providers




01880 Services Provided: Inpatient Surgical Provided by Staff and Arrangement

SVCS PROV2190





02360 Services Provided: Occupational Therapy Provided under Arrangement SVCS PROV2270



02260 Services Provided: Operating Rooms Provided by Staff and Arrangement

SVCS PROV2300








SVCS PROV2410



SVCS PROV2440













00410 Type of Facility Short - Term PROV2890

00300 ZIP Code 33418 PROV2905




00260 Termination Code 1 Other - Status Change PROV4770



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7/29/2015

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00840 Fax Phone Number 5618420271 PROV9015



100309

SELECT SPECIALTY HOSPITAL - PALM BEACH, INC










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SVCS PROV2270






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SVCS PROV2365

02820 Services Provided: Physical Therapy Provided by Staff and Arrangement

SVCS PROV2370




SVCS PROV2440






SVCS PROV2505









00300 ZIP Code 33461 PROV2905


















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7/29/2015

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100288

ST MARY'S MEDICAL CENTER





















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01110 Psychiatric Unit Effective Date 06/01/2011 DATE PROV1695

01120 Psychiatric Unit Switch Yes PROV1700

01130 Psychiatric Unit Termination Code Active PROV1705

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01160 Rehabilitation Unit Effective Date 06/01/2011 DATE PROV1735

01170 Rehabilitation Unit Switch Yes PROV1740

01180 Rehabilitation Unit Termination Code Active PROV1745




01210 Services Provided: Acute Renal Dialysis Provided by Staff SVCS PROV2055


01280 Services Provided: Anesthesia Provided by Staff SVCS PROV2070



01530 Services Provided: ICU Cardiac (non-surgical) Provided by Staff SVCS PROV2110






02040 Services Provided: Neonatal Nursery Provided by Staff SVCS PROV2235

02100 Services Provided: Nuclear Medicine Provided by Staff SVCS PROV2245

02200 Services Provided: Obstetrics Provided by Staff SVCS PROV2265


01400 Services Provided: Cardiac - Thoracic Surgery Provided by Staff SVCS PROV2285


02260 Services Provided: Operating Rooms Provided by Staff SVCS PROV2300



02480 Services Provided: Outpatient Surgery Provided by Staff SVCS PROV2355

02500 Services Provided: Pediatric Provided by Staff SVCS PROV2360



02720 Services Provided: Postoperative Recovery Room Provided by Staff SVCS PROV2410


01650 Services Provided: Radiology (Diagnostic) Provided by Staff SVCS PROV2440

03230 Services Provided: Radiology (Therapeutic) Provided by Staff SVCS PROV2445


01630 Services Provided: Trauma Center (Designated) Provided by Staff SVCS PROV2475



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7/29/2015

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00300 ZIP Code 33407 PROV2905






01440 Services Provided: Chemotherapy Provided by Staff SVCS PROV6170


01720 Services Provided: Emergency Dept(Dedicated) Provided by Staff SVCS PROV6180

01760 Services Provided: Extracorporeal Shock Wave Provided under Arrangement SVCS PROV6185


02020 Services Provided: ICU Neonatal Provided by Staff SVCS PROV6195

02520 Services Provided: ICU Pediatric Provided by Staff SVCS PROV6200

03120 Services Provided: ICU Surgical Provided by Staff SVCS PROV6205

02000 Services Provided: Magnetic Resonance Imaging Provided by Staff SVCS PROV6210

02060 Services Provided: Neurosurgical Services Provided by Staff SVCS PROV6215


02280 Services Provided: Orthopedic Surgery Provided by Staff SVCS PROV6225








02460 Services Provided: Rehabilitation Outpatient Provided by Staff SVCS PROV6265

01420 Services Provided: CARF Inpatient Rehabilitation C Provided by Staff SVCS PROV6270







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7/29/2015

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100287

GOOD SAMARITAN MEDICAL CENTER




































4:45 PM

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7/29/2015

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02080 Services Provided: Organ Transplant (Not Medicare Provided by Staff SVCS PROV2315






















00300 ZIP Code 33401 PROV2905







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01720 Services Provided: Emergency Dept(Dedicated) Provided by Staff and Arrangement

SVCS PROV6180




























100275

WELLINGTON REGIONAL MEDICAL CENTER

WELLINGTON, FL 33414






00390 Affiliated Resident Program: Osteopathic Y PR201304



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7/29/2015

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00930 Medical School Affiliation Major PROV0645























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7/29/2015

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01260 Services Provided: Alcohol and/or Drug Provided by Staff SVCS PROV2065





01580 Services Provided: Dental Provided by Staff SVCS PROV2120












02080 Services Provided: Organ Transplant (Not Medicare Provided under Arrangement SVCS PROV2315



4:45 PM

www.Halmanac.com


7/29/2015

All Providers













02980 Services Provided: Social Provided under Arrangement SVCS PROV2485










00300 ZIP Code 33414 PROV2905






















4:45 PM

www.Halmanac.com


7/29/2015

All Providers


















100269

PALMS WEST HOSPITAL

LOXAHATCHEE, FL 33470
























4:45 PM

www.Halmanac.com


7/29/2015

All Providers







00930 Medical School Affiliation Graduate PROV0645






















01010 Regional Override # 3 (Nurse - Bed) Yes PROV1555
















4:45 PM

www.Halmanac.com


7/29/2015

All Providers













































4:45 PM

www.Halmanac.com


7/29/2015

All Providers








00300 ZIP Code 33470 PROV2905





01310 Services Provided: Audiology Provided under Arrangement SVCS PROV6160











02220 Services Provided: Ophthalmic Surgery Provided by Staff SVCS PROV6220








02870 Services Provided: Reconstructive Surgery Provided by Staff SVCS PROV6260












4:45 PM

www.Halmanac.com


7/29/2015

All Providers




100268

WEST BOCA MEDICAL CENTER

BOCA RATON, FL 33428















00040 Change of Ownership Date 09/12/2003 DATE PROV0100























4:45 PM

www.Halmanac.com


7/29/2015

All Providers



















00160 Prior Change of Ownership Date 06/01/2003 DATE PROV1615
























01670 Services Provided: Dietary Provided under Arrangement SVCS PROV2130


4:45 PM

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7/29/2015

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00300 ZIP Code 33428 PROV2905









SVCS PROV6180

4:45 PM

www.Halmanac.com


7/29/2015

All Providers































100262

GOOD SAMARITAN HOSPITAL












4:45 PM

www.Halmanac.com


7/29/2015

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4:45 PM

www.Halmanac.com


7/29/2015

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00300 ZIP Code 33401 PROV2905




00260 Termination Code 1 Voluntary - Other PROV4770





SVCS PROV6180















4:45 PM

www.Halmanac.com


7/29/2015

All Providers

















100258

DELRAY MEDICAL CENTER


























4:45 PM

www.Halmanac.com


7/29/2015

All Providers













































4:45 PM

www.Halmanac.com


7/29/2015

All Providers







00300 ZIP Code 33484 PROV2905









SVCS PROV6180




























4:45 PM

www.Halmanac.com


7/29/2015

All Providers




100253

JUPITER MEDICAL CENTER

JUPITER, FL 33458






































4:45 PM

www.Halmanac.com


7/29/2015

All Providers













































4:45 PM

www.Halmanac.com


7/29/2015

All Providers




01880 Services Provided: Inpatient Surgical Provided under Arrangement SVCS PROV2190












02500 Services Provided: Pediatric Provided by Staff and Arrangement

SVCS PROV2360








01630 Services Provided: Trauma Center (Designated) Provided under Arrangement SVCS PROV2475











00300 ZIP Code 33458 PROV2905









4:45 PM

www.Halmanac.com


7/29/2015

All Providers










02060 Services Provided: Neurosurgical Services Provided by Staff and Arrangement

SVCS PROV6215



02540 Services Provided: PET Scan Services Provided by Staff SVCS PROV6230


















100234

WEST PALM HOSPITAL












4:45 PM

www.Halmanac.com


7/29/2015

All Providers













































4:45 PM

www.Halmanac.com


7/29/2015

All Providers






































02240 Services Provided: Optometric Provided by Staff SVCS PROV2295







4:45 PM

www.Halmanac.com


7/29/2015

All Providers





















00300 ZIP Code 33407 PROV2905
























4:45 PM

www.Halmanac.com


7/29/2015

All Providers
















100207

PALM BEACH REGIONAL HOSPITAL



























4:45 PM

www.Halmanac.com


7/29/2015

All Providers













































4:45 PM

www.Halmanac.com


7/29/2015

All Providers






00300 ZIP Code 33460 PROV2905




00260 Termination Code 1 Voluntary - Reimburse PROV4770
































4:45 PM

www.Halmanac.com


7/29/2015

All Providers




100176

PALM BEACH GARDENS MEDICAL CENTER

PALM BEACH GARDENS, FL 33410






































4:45 PM

www.Halmanac.com


7/29/2015

All Providers













































4:45 PM

www.Halmanac.com


7/29/2015

All Providers













02080 Services Provided: Organ Transplant (Not Medicare Provided under Arrangement SVCS PROV2315









SVCS PROV2440

03230 Services Provided: Radiology (Therapeutic) Provided by Staff and Arrangement

SVCS PROV2445













00300 ZIP Code 33410 PROV2905





01310 Services Provided: Audiology Provided under Arrangement SVCS PROV6160



4:45 PM

www.Halmanac.com


7/29/2015

All Providers





SVCS PROV6180







02060 Services Provided: Neurosurgical Services Provided by Staff and Arrangement

SVCS PROV6215



02540 Services Provided: PET Scan Services Provided under Arrangement SVCS PROV6230


















100168

BOCA RATON REGIONAL HOSPITAL

BOCA RATON, FL 33486









4:45 PM

www.Halmanac.com


7/29/2015

All Providers













































4:45 PM

www.Halmanac.com


7/29/2015

All Providers























00300 ZIP Code 33486 PROV2905






















4:45 PM

www.Halmanac.com


7/29/2015

All Providers


















100144

EVERGLADES MEMORIAL HOSPITAL

PAHOKEE, FL 33476
























4:45 PM

www.Halmanac.com


7/29/2015

All Providers













































4:45 PM

www.Halmanac.com


7/29/2015

All Providers








00300 ZIP Code 33476 PROV2905




































4:45 PM

www.Halmanac.com


7/29/2015

All Providers




100130

LAKESIDE MEDICAL CENTER

BELLE GLADE, FL 33430






































4:45 PM

www.Halmanac.com


7/29/2015

All Providers













































4:45 PM

www.Halmanac.com


7/29/2015

All Providers

































00290 General Type of Control Code Government - Hospital District/Auth

PROV2885


00300 ZIP Code 33430 PROV2905









4:45 PM

www.Halmanac.com


7/29/2015

All Providers




















02460 Services Provided: Rehabilitation Outpatient Provided under Arrangement SVCS PROV6265

01420 Services Provided: CARF Inpatient Rehabilitation C Provided under Arrangement SVCS PROV6270










104033

FAIR OAKS HOSP OF BOCA/DELRAY












4:45 PM

www.Halmanac.com


7/29/2015

All Providers













































4:45 PM

www.Halmanac.com


7/29/2015

All Providers





























01670 Services Provided: Dietary Not Provided SVCS PROV2130
















4:45 PM

www.Halmanac.com


7/29/2015

All Providers















00230 State Region Code MIA PROV2710






00300 ZIP Code 33445 PROV2905
























4:45 PM

www.Halmanac.com


7/29/2015

All Providers
















104060

FAIR OAKS PAVILLION AT DELRAY MEDICAL



























4:45 PM

www.Halmanac.com


7/29/2015

All Providers













































4:45 PM

www.Halmanac.com


7/29/2015

All Providers








01260 Services Provided: Alcohol and/or Drug Provided by Staff and Arrangement

SVCS PROV2065




































4:45 PM

www.Halmanac.com


7/29/2015

All Providers







00300 ZIP Code 33484 PROV2905




































4:45 PM

www.Halmanac.com


7/29/2015

All Providers




104061

GLENBEIGH HOSP OF THE PALM BEACHES INC







































4:45 PM

www.Halmanac.com


7/29/2015

All Providers













































4:45 PM

www.Halmanac.com


7/29/2015

All Providers














02420 Services Provided: Outpatient Provided by Staff and Arrangement

SVCS PROV2350






01230 Services Provided: Psychiatric - Adult Inpatient Provided by Staff and Arrangement

SVCS PROV2415















00300 ZIP Code 33407 PROV2905









4:45 PM

www.Halmanac.com


7/29/2015

All Providers































100080

JFK MEDICAL CENTER

ATLANTIS, FL 33462







00400 Affiliated Resident Program: Other Y PR201305




4:45 PM

www.Halmanac.com


7/29/2015

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4:45 PM

www.Halmanac.com


7/29/2015

All Providers





















00300 ZIP Code 33462 PROV2905
























4:45 PM

www.Halmanac.com


7/29/2015

All Providers
















100010

ST MARYS HOSPITAL INC



























4:45 PM

www.Halmanac.com


7/29/2015

All Providers






































01130 Psychiatric Unit Termination Code Voluntary-Other PROV1705

01140 Psychiatric Unit Termination Date 07/01/2001 DATE PROV1710





01180 Rehabilitation Unit Termination Code Voluntary-Other PROV1745

4:45 PM

www.Halmanac.com


7/29/2015

All Providers




01190 Rehabilitation Unit Termination Date 07/01/2001 DATE PROV1750






















02420 Services Provided: Outpatient Provided by Staff and Arrangement

SVCS PROV2350

02480 Services Provided: Outpatient Surgery Provided by Staff and Arrangement

SVCS PROV2355





SVCS PROV2410



03230 Services Provided: Radiology (Therapeutic) Provided under Arrangement SVCS PROV2445









4:45 PM

www.Halmanac.com


7/29/2015

All Providers








00300 ZIP Code 33407 PROV2905




































4:45 PM

www.Halmanac.com


7/29/2015

All Providers




100002

BETHESDA HOSPITAL EAST

BOYNTON BEACH, FL 33435






































4:45 PM

www.Halmanac.com


7/29/2015

All Providers


























01130 Psychiatric Unit Termination Code Voluntary - Merger or Close PROV1705

01140 Psychiatric Unit Termination Date 01/25/2000 DATE PROV1710


















4:45 PM

www.Halmanac.com


7/29/2015

All Providers



































00300 ZIP Code 33435 PROV2905





01310 Services Provided: Audiology Provided by Staff SVCS PROV6160




SVCS PROV6180

4:45 PM

www.Halmanac.com


7/29/2015

All Providers






02020 Services Provided: ICU Neonatal Provided by Staff SVCS PROV6195

























4:45 PM

www.Halmanac.com


7/29/2015

All Providers




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