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
15C0001018 Grossnickle Eye Center Inc 2251 Dubois Dr Warsaw IN 5 (Chicago) 12/08/2022 5E434-L1 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
15C0001018 Grossnickle Eye Center Inc 2251 Dubois Dr Warsaw IN 5 (Chicago) 11/27/2018 WK8321 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
K0131 Multiple Occupancies Standard
K0291 Emergency Lighting Standard
K0511 Utilities - Gas and Electric Standard
K0521 HVAC Standard
15C0001018 Grossnickle Eye Center Inc 2251 Dubois Dr Warsaw IN 5 (Chicago) 11/15/2018 WK8311 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0221 NOTICE OF RIGHTS Standard
Q0222 NOTICE OF RIGHTS - POSTING Standard
Q0241 SANITARY ENVIRONMENT Standard
15C0001019 Indiana University Health Ambulatory Surgery Centers, Llc 8501 Harcourt Rd Indianapolis IN 5 (Chicago) 07/16/2024 63EFA-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0242 INFECTION CONTROL PROGRAM Standard
Q0244 INFECTION CONTROL PROGRAM - QAPI Standard
15C0001019 Indiana University Health Ambulatory Surgery Centers, Llc 8501 Harcourt Rd Indianapolis IN 5 (Chicago) 12/11/2023 6193F-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
15C0001019 Indiana University Health Ambulatory Surgery Centers, Llc 8501 Harcourt Rd Indianapolis IN 5 (Chicago) 12/11/2023 6193F-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0037 EP Training Program 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
K0906 Gas and Vacuum Piped Systems ? Central Supply System Operations Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
15C0001019 Indiana University Health Ambulatory Surgery Centers, Llc 8501 Harcourt Rd Indianapolis IN 5 (Chicago) 02/13/2020 P0R321 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0100 General Requirements - Other Standard
K0131 Multiple Occupancies Standard
K0271 Discharge from Exits Standard
K0341 Fire Alarm System - Installation Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0712 Fire Drills Standard
K0901 Fundamentals - Building System Categories Standard
K0906 Gas and Vacuum Piped Systems ? Central Supply System Operations Standard
K0913 Electrical Systems - Wet Procedure Locations Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0933 Features of Fire Protection ? Fire Loss Prevention Standard
15C0001019 Indiana University Health Ambulatory Surgery Centers, Llc 8501 Harcourt Rd Indianapolis IN 5 (Chicago) 01/28/2020 P0R311 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
Q0109 EMERGENCY EQUIPMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
15C0001020 Eye Surgery Center Of New Albany, Llc 520 W First St New Albany IN 5 (Chicago) 02/20/2026 1E40CD-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
K0355 Portable Fire Extinguishers Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0781 Portable Space Heaters Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
15C0001020 Eye Surgery Center Of New Albany, Llc 520 W First St New Albany IN 5 (Chicago) 02/17/2026 1E40CD-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
Q0241 SANITARY ENVIRONMENT Standard