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
▼ 10C0001154 Mid-Florida Surgery Center 17564 W Hwy 441 Mount Dora FL 4 (Atlanta) 09/19/2019 ZVIL11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 10C0001154 Mid-Florida Surgery Center 17564 W Hwy 441 Mount Dora FL 4 (Atlanta) 09/17/2019 ZVIL21 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
K0914 Electrical Systems - Maintenance and Testing Standard
▼ 10C0001156 Boca Raton Outpatient Surgery & Laser Center, Llc 501 Glades Rd Boca Raton FL 4 (Atlanta) 09/15/2023 60B04-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0162 FORM AND CONTENT OF RECORD Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0243 INFECTION CONTROL PROGRAM - DIRECTION Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
Q0266 DISCHARGE - ORDER Standard
▼ 10C0001156 Boca Raton Outpatient Surgery & Laser Center, Llc 501 Glades Rd Boca Raton FL 4 (Atlanta) 09/17/2018 11G721 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0007 EP Program Patient Population Standard
E0018 Procedures for Tracking of Staff and Patients Standard
K0211 Means of Egress - General Standard
K0371 Subdivision of Building Spaces ? Smoke Compartments Standard
K0521 HVAC Standard
▼ 10C0001156 Boca Raton Outpatient Surgery & Laser Center, Llc 501 Glades Rd Boca Raton FL 4 (Atlanta) 09/11/2018 11G711 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0162 FORM AND CONTENT OF RECORD Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
▼ 10C0001159 Countryside Surgery Center 3291 N Mcmullen Booth Rd Clearwater FL 4 (Atlanta) 04/02/2024 6253E-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0929 Gas Equipment ? Precautions for Handling Oxygen Standard
▼ 10C0001159 Countryside Surgery Center 3291 N Mcmullen Booth Rd Clearwater FL 4 (Atlanta) 02/27/2019 UK1911 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0041 CONTRACT SERVICES Standard
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0122 REAPPRAISALS Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0184 VERBAL ORDERS Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
▼ 10C0001159 Countryside Surgery Center 3291 N Mcmullen Booth Rd Clearwater FL 4 (Atlanta) 05/25/2018 9VPZ11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0162 FORM AND CONTENT OF RECORD Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0261 ADMISSION ASSESSMENT Standard
▼ 10C0001159 Countryside Surgery Center 3291 N Mcmullen Booth Rd Clearwater FL 4 (Atlanta) 05/24/2018 9VPZ21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0022 Policies/Procedures for Sheltering in Place Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0907 Gas and Vacuum Piped Systems ? Central Supply System Location Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 10C0001162 Parkside Surgery Center 2731 Park Street Jacksonville FL 4 (Atlanta) 10/10/2023 60B0E-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
K0912 Electrical Systems - Receptacles Standard