S&C QCOR ASC 2567s
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ASCs 2567s
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Time Interval

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Provider Characteristics

Use these filters if you want to limit the report to providers that have certain characteristics. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

Survey Type & Deficiency Tags

Use these filters if you want to limit the reports to providers on specific survey types, or to reports that were cited for specific ASC deficiency tags and tag types. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

CCN and Facility Name

Use these filters if you know the name (or partial name) of the facility you are searching for, or the CMS Certification Number (CCN) for the facility you are searching for.

Other Survey Characteristics

Select one of the options below to filter by surveys that cite deficiencies or by surveys that are deficiency-free. By default, only surveys that cite deficiencies are displayed. Selecting "All" displays all surveys.

CMS Certification Number Facility Name Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 10C0001129 Samuel Wells Surgicenter, Inc 3599 University Blvd South Jacksonville FL 4 (Atlanta) 01/28/2025 6514A-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0914 Electrical Systems - Maintenance and Testing Standard
▼ 10C0001129 Samuel Wells Surgicenter, Inc 3599 University Blvd South Jacksonville FL 4 (Atlanta) 01/18/2018 OCP511 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0105 EMERGENCY EQUIPMENT Standard
Q0181 ADMINISTRATION OF DRUGS Standard
▼ 10C0001129 Samuel Wells Surgicenter, Inc 3599 University Blvd South Jacksonville FL 4 (Atlanta) 01/16/2018 OCP521 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0001 Establishment of the Emergency Program (EP) Condition
▼ 10C0001131 Kissimmee Surgicare, Ltd 2275 N Central Ave Kissimmee FL 4 (Atlanta) 06/02/2023 5F2D1-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0266 DISCHARGE - ORDER Standard
▼ 10C0001131 Kissimmee Surgicare, Ltd 2275 N Central Ave Kissimmee FL 4 (Atlanta) 05/31/2023 5F2D1-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0211 Means of Egress - General Standard
▼ 10C0001131 Kissimmee Surgicare, Ltd 2275 N Central Ave Kissimmee FL 4 (Atlanta) 07/03/2018 Z3O611 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0042 HOSPITALIZATION Standard
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0221 NOTICE OF RIGHTS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0261 ADMISSION ASSESSMENT Standard
Q0266 DISCHARGE - ORDER Standard
Q0267 DISCHARGE WITH RESPONSIBLE ADULT Standard
▼ 10C0001132 Space Coast Surgical Center, Ltd 220 N Sykes Creek Pkwy Suite 101 Merritt Island FL 4 (Atlanta) 08/10/2021 29GM11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0181 ADMINISTRATION OF DRUGS Standard
▼ 10C0001134 Hillmoor Eye Surgery Center Llc 1715 Se Tiffany Avenue Port Saint Lucie FL 4 (Atlanta) 09/30/2022 4F5D8-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0345 Fire Alarm System - Testing and Maintenance Standard
K0712 Fire Drills Standard
▼ 10C0001134 Hillmoor Eye Surgery Center Llc 1715 Se Tiffany Avenue Port Saint Lucie FL 4 (Atlanta) 09/14/2022 4F5D8-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0181 ADMINISTRATION OF DRUGS Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
Q0267 DISCHARGE WITH RESPONSIBLE ADULT Standard
▼ 10C0001135 F Nicholas Gahhos, Md, Pa 135 San Marco Dr Venice FL 4 (Atlanta) 04/02/2018 I0CF21 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0013 Development of EP Policies and Procedures Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard