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
▼ 03C0001093 Aims Outpatient Surgery Center Inc. 3636 Stockton Hill Road Kingman AZ 9 (San Francisco) 03/06/2019 G4RV11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0006 Plan Based on All Hazards Risk Assessment Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0018 Procedures for Tracking of Staff and Patients Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0029 Development of Communication Plan Standard
E0030 Names and Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0034 Information on Occupancy/Needs Standard
E0036 EP Training and Testing Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
▼ 03C0001093 Aims Outpatient Surgery Center Inc. 3636 Stockton Hill Road Kingman AZ 9 (San Francisco) 03/06/2019 G4RV21 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0321 Hazardous Areas - Enclosure Standard
K0346 Fire Alarm System - Out of Service Standard
K0354 Sprinkler System - Out of Service Standard
K0511 Utilities - Gas and Electric Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0907 Gas and Vacuum Piped Systems ? Central Supply System Location Standard
K0908 Gas and Vacuum Piped Systems ? Central Supply System Alarms Standard
K0913 Electrical Systems - Wet Procedure Locations Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
K0933 Features of Fire Protection ? Fire Loss Prevention Standard
▼ 03C0001202 Rummel Eye Care/Eye Surgery Services 1022 Willow Creek Road, Suites 103 And 104 Prescott AZ 9 (San Francisco) 12/27/2022 5E781-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0291 Emergency Lighting Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0372 Subdivision of Building Spaces ? Smoke Barrier Construction Standard
K0906 Gas and Vacuum Piped Systems ? Central Supply System Operations Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 03C0001202 Rummel Eye Care/Eye Surgery Services 1022 Willow Creek Road, Suites 103 And 104 Prescott AZ 9 (San Francisco) 12/15/2022 5E781-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0181 ADMINISTRATION OF DRUGS Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 03C0001202 Rummel Eye Care/Eye Surgery Services 1022 Willow Creek Road, Suites 103 And 104 Prescott AZ 9 (San Francisco) 12/19/2019 S36E21 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0293 Exit Signage Standard
K0914 Electrical Systems - Maintenance and Testing Standard
▼ 03C0001203 Banner Desert Surgery Center 1500 South Dobson Road, Suite 101 Mesa AZ 9 (San Francisco) 04/14/2022 S1EH11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 03C0001203 Banner Desert Surgery Center 1500 South Dobson Road, Suite 101 Mesa AZ 9 (San Francisco) 04/14/2022 S1EH21 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0353 Sprinkler System - Maintenance and Testing Standard
K0511 Utilities - Gas and Electric Standard
▼ 03C0001203 Banner Desert Surgery Center 1500 South Dobson Road, Suite 101 Mesa AZ 9 (San Francisco) 05/20/2019 HUG121 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0291 Emergency Lighting Standard
K0341 Fire Alarm System - Installation Standard
K0511 Utilities - Gas and Electric Standard
▼ 03C0001207 Arizona Ophthalmic Outpatient Surgery 300 East Osborn, Suite 102 Phoenix AZ 9 (San Francisco) 04/12/2021 1NE011 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0013 Development of EP Policies and Procedures Standard
E0039 EP Testing Requirements Standard
▼ 03C0001207 Arizona Ophthalmic Outpatient Surgery 300 East Osborn, Suite 102 Phoenix AZ 9 (San Francisco) 04/12/2021 1NE021 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0341 Fire Alarm System - Installation Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0351 Sprinkler System - Installation Standard
K0911 Electrical Systems - Other Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard