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
▼ 10C0001489 Clinic Surgery Center, Llc 2407 Cypress Ridge Blvd Wesley Chapel FL 4 (Atlanta) 07/09/2024 63213-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0229 EXERCISE OF RIGHTS - INFORMED CONSENT Standard
▼ 10C0001489 Clinic Surgery Center, Llc 2407 Cypress Ridge Blvd Wesley Chapel FL 4 (Atlanta) 06/12/2019 4MSU21 Recertification
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
E0007 EP Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0034 Information on Occupancy/Needs Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
▼ 10C0001494 Surgery Center Of Jacksonville, Llc 10475 Centurion Parkway North Jacksonville FL 4 (Atlanta) 05/09/2018 PPOU21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
▼ 10C0001498 St Mark's Surgical Center Llc 6820 International Center Blvd Fort Myers FL 4 (Atlanta) 04/07/2022 TJ5F21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
K0929 Gas Equipment ? Precautions for Handling Oxygen Standard
▼ 10C0001498 St Mark's Surgical Center Llc 6820 International Center Blvd Fort Myers FL 4 (Atlanta) 07/22/2021 UQXN11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0160 MEDICAL RECORDS Condition
Q0162 FORM AND CONTENT OF RECORD Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
▼ 10C0001498 St Mark's Surgical Center Llc 6820 International Center Blvd Fort Myers FL 4 (Atlanta) 07/21/2021 UQXN21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0761 Maintenance, Inspection & Testing - Doors Standard
▼ 10C0001499 Southeastern Outpatient Surgery Center, Llc 2030 Fleischmann Rd Tallahassee FL 4 (Atlanta) 03/05/2020 0C1K11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0184 VERBAL ORDERS Standard
▼ 10C0001504 Gold Coast Surgery Center, Llc 1750 Englewood Rd Englewood FL 4 (Atlanta) 01/16/2019 B0XB21 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
E0006 Plan Based on All Hazards Risk Assessment Standard
E0022 Policies/Procedures for Sheltering in Place Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0036 EP Training and Testing Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0711 Evacuation and Relocation Plan Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 10C0001505 Lake Endoscopy Center 17355 Se 109th Terrace Road Summerfield FL 4 (Atlanta) 08/14/2024 63987-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0141 ORGANIZATION AND STAFFING Standard
▼ 10C0001505 Lake Endoscopy Center 17355 Se 109th Terrace Road Summerfield FL 4 (Atlanta) 08/13/2024 63987-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
K0912 Electrical Systems - Receptacles Standard