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
▼ 03C0001300 Surgery Center At River Road 2490 East River Road, Suite 150 Tucson AZ 9 (San Francisco) 03/02/2022 5W7021 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
▼ 03C0001301 Kokopelli Eye Care 412 Whipple Street Prescott AZ 9 (San Francisco) 08/15/2018 PA6311 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
E0009 Local, State, Tribal Collaboration Process Standard
E0022 Policies/Procedures for Sheltering in Place Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
▼ 03C0001301 Kokopelli Eye Care 412 Whipple Street Prescott AZ 9 (San Francisco) 08/15/2018 PA6321 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0211 Means of Egress - General Standard
K0907 Gas and Vacuum Piped Systems ? Central Supply System Location Standard
K0908 Gas and Vacuum Piped Systems ? Central Supply System Alarms Standard
▼ 03C0001302 Metro Surgery Center, Llc 6790 West Thunderbird Road Peoria AZ 9 (San Francisco) 10/05/2020 9AYW11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 03C0001302 Metro Surgery Center, Llc 6790 West Thunderbird Road Peoria AZ 9 (San Francisco) 10/05/2020 9AYW21 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0521 HVAC Standard
▼ 03C0001303 Central Arizona Endoscopy, Llc 2158 North Gilbert Road, Building 1, Suite 103 Mesa AZ 9 (San Francisco) 01/27/2022 VHIH11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
E0007 EP Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0031 Emergency Officials Contact Information Standard
E0034 Information on Occupancy/Needs Standard
E0036 EP Training and Testing Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
▼ 03C0001303 Central Arizona Endoscopy, Llc 2158 North Gilbert Road, Building 1, Suite 103 Mesa AZ 9 (San Francisco) 01/27/2022 VHIH21 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0341 Fire Alarm System - Installation Standard
K0353 Sprinkler System - Maintenance and Testing Standard
▼ 03C0001303 Central Arizona Endoscopy, Llc 2158 North Gilbert Road, Building 1, Suite 103 Mesa AZ 9 (San Francisco) 05/08/2019 BK0D11 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
E0009 Local, State, Tribal Collaboration Process Standard
E0018 Procedures for Tracking of Staff and Patients Standard
E0022 Policies/Procedures for Sheltering in Place Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0034 Information on Occupancy/Needs Standard
E0039 EP Testing Requirements Standard
Q0061 ANESTHETIC RISK AND EVALUATION Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 03C0001303 Central Arizona Endoscopy, Llc 2158 North Gilbert Road, Building 1, Suite 103 Mesa AZ 9 (San Francisco) 05/08/2019 BK0D21 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0511 Utilities - Gas and Electric Standard
K0712 Fire Drills Standard
▼ 03C0001304 Arrowhead Endoscopy & Pain Management Center Llc 7168 West Campo Bello Drive Suite A Glendale AZ 9 (San Francisco) 01/17/2024 61CF6-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0020 Policies for Evac. and Primary/Alt. Comm. Standard
E0032 Primary/Alternate Means for Communication Standard
E0034 Information on Occupancy/Needs Standard
K0131 Multiple Occupancies Standard
K0353 Sprinkler System - Maintenance and Testing Standard