S&C QCOR ASC 2567s
d QCOR: Quality, Certification and Oversight Reports. S&C QCOR  
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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
▼ 15C0001033 North Campus Surgery Center Llc 8040 Clearvista Pkwy Ste 150 Indianapolis IN 5 (Chicago) 02/04/2025 6521B-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
Q0162 FORM AND CONTENT OF RECORD Standard
▼ 15C0001033 North Campus Surgery Center Llc 8040 Clearvista Pkwy Ste 150 Indianapolis IN 5 (Chicago) 02/04/2025 6521B-L1 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
K0311 Vertical Openings - Enclosure Standard
K0323 Anesthetizing Locations Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0372 Subdivision of Building Spaces ? Smoke Barrier Construction Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
▼ 15C0001033 North Campus Surgery Center Llc 8040 Clearvista Pkwy Ste 150 Indianapolis IN 5 (Chicago) 02/15/2018 YD8R11 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0241 SANITARY ENVIRONMENT Standard
▼ 15C0001034 Northwest Surgery Center Llc 8651 Township Line Road Indianapolis IN 5 (Chicago) 08/01/2019 56J521 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0018 Procedures for Tracking of Staff and Patients Standard
E0022 Policies/Procedures for Sheltering in Place Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
K0354 Sprinkler System - Out of Service Standard
K0712 Fire Drills Standard
▼ 15C0001034 Northwest Surgery Center Llc 8651 Township Line Road Indianapolis IN 5 (Chicago) 07/17/2019 56J511 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
▼ 15C0001036 Novamed Surgery Center Of Merrillville 9797 Massachusetts Street Crown Point IN 5 (Chicago) 12/05/2023 61873-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
▼ 15C0001036 Novamed Surgery Center Of Merrillville 9797 Massachusetts Street Crown Point IN 5 (Chicago) 01/23/2020 J24V21 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
▼ 15C0001037 Southern Indiana Surgery Center Llc 2800 Rex Grossman Blvd Bloomington IN 5 (Chicago) 09/01/2022 4F43B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0020 COMPLIANCE WITH STATE LICENSURE LAW Condition
Q0100 ENVIRONMENT Condition
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0083 PERFORMANCE IMPROVEMENT PROJECTS Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0107 DOORS TO HAZARDOUS AREAS Standard
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0243 INFECTION CONTROL PROGRAM - DIRECTION Standard
Q0245 INFECTION CONTROL PROGRAM Standard
▼ 15C0001037 Southern Indiana Surgery Center Llc 2800 Rex Grossman Blvd Bloomington IN 5 (Chicago) 09/01/2022 4F43B-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0321 Hazardous Areas - Enclosure Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 15C0001037 Southern Indiana Surgery Center Llc 2800 Rex Grossman Blvd Bloomington IN 5 (Chicago) 10/17/2018 CVUW11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0181 ADMINISTRATION OF DRUGS Standard