S&C QCOR ASC 2567s
d QCOR:  Quality, Certification and Oversight Reports.
ASCs 2567s
Selection Criteria

Time Interval

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Provider Characteristics

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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
14C0001189 Pcac Gi Jv Llc 331 West Surf St, Ste 506 Chicago IL 5 (Chicago) 09/10/2024 64069-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0266 DISCHARGE - ORDER Standard
14C0001189 Pcac Gi Jv Llc 331 West Surf St, Ste 506 Chicago IL 5 (Chicago) 09/10/2024 64069-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0293 Exit Signage Standard
K0351 Sprinkler System - Installation Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0902 Gas and Vacuum Piped Systems - Other Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
15C0001005 New Albany Outpatient Surgery, Llc 2201 Green Valley Rd New Albany IN 5 (Chicago) 12/18/2019 P0YZ21 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
K0712 Fire Drills Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
15C0001005 New Albany Outpatient Surgery, Llc 2201 Green Valley Rd New Albany IN 5 (Chicago) 11/19/2019 P0YZ11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0084 GOVERNING BODY RESPONSIBILITIES Standard
Q0242 INFECTION CONTROL PROGRAM Standard
15C0001007 The South Bend Clinic Llc 211 N Eddy St South Bend IN 5 (Chicago) 02/06/2025 65413-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
15C0001007 The South Bend Clinic Llc 211 N Eddy St South Bend IN 5 (Chicago) 02/06/2025 65413-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
K0346 Fire Alarm System - Out of Service Standard
K0354 Sprinkler System - Out of Service Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
15C0001011 Surgical Care Center Inc 9202 N Meridian Street Suite 150 Indianapolis IN 5 (Chicago) 08/05/2024 63AE7-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE Standard
Q0108 BUILDING SAFETY Standard
15C0001011 Surgical Care Center Inc 9202 N Meridian Street Suite 150 Indianapolis IN 5 (Chicago) 08/05/2024 63AE7-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0291 Emergency Lighting Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0907 Gas and Vacuum Piped Systems ? Central Supply System Location Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
15C0001011 Surgical Care Center Inc 9202 N Meridian Street Suite 150 Indianapolis IN 5 (Chicago) 01/29/2021 LTI421 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
K0241 Number of Exits - Story and Compartment Standard
K0291 Emergency Lighting Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0913 Electrical Systems - Wet Procedure Locations Standard
K0916 Essential Electrical Systems ? Alarm Annunciator Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
15C0001011 Surgical Care Center Inc 9202 N Meridian Street Suite 150 Indianapolis IN 5 (Chicago) 01/27/2021 LTI411 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0108 BUILDING SAFETY Standard
Q0242 INFECTION CONTROL PROGRAM Standard