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
15C0001041 Sagamore Surgical Services Inc 2320 Concord Road, Suite B Lafayette IN 5 (Chicago) 01/23/2023 5EA7D-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0242 INFECTION CONTROL PROGRAM Standard
15C0001041 Sagamore Surgical Services Inc 2320 Concord Road, Suite B Lafayette IN 5 (Chicago) 01/23/2023 5EA7D-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
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
15C0001041 Sagamore Surgical Services Inc 2320 Concord Road, Suite B Lafayette IN 5 (Chicago) 04/22/2019 ERF021 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0341 Fire Alarm System - Installation Standard
15C0001045 Indiana Endoscopy Centers 1801 N Senate Blvd, Ste 710 Indianapolis IN 5 (Chicago) 02/10/2025 65320-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
15C0001045 Indiana Endoscopy Centers 1801 N Senate Blvd, Ste 710 Indianapolis IN 5 (Chicago) 02/10/2025 65320-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
K0907 Gas and Vacuum Piped Systems ? Central Supply System Location Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
15C0001045 Indiana Endoscopy Centers 1801 N Senate Blvd, Ste 710 Indianapolis IN 5 (Chicago) 03/30/2021 5I4Y21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0039 EP Testing Requirements Standard
K0131 Multiple Occupancies Standard
K0223 Doors with Self-Closing Devices Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0351 Sprinkler System - Installation Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0521 HVAC Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0906 Gas and Vacuum Piped Systems ? Central Supply System Operations Standard
K0911 Electrical Systems - Other Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
15C0001045 Indiana Endoscopy Centers 1801 N Senate Blvd, Ste 710 Indianapolis IN 5 (Chicago) 03/25/2021 5I4Y11 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
15C0001046 North Meridian Street Surgicenter & Assoiciates Llc 13225 N Meridian Street Carmel IN 5 (Chicago) 02/12/2024 62233-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0265 DISCHARGE - SUPPLIES AND INFORMATION Standard
Q0266 DISCHARGE - ORDER Standard
15C0001046 North Meridian Street Surgicenter & Assoiciates Llc 13225 N Meridian Street Carmel IN 5 (Chicago) 02/12/2024 62233-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
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
15C0001046 North Meridian Street Surgicenter & Assoiciates Llc 13225 N Meridian Street Carmel IN 5 (Chicago) 10/26/2020 URF821 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0026 Roles Under a Waiver Declared by Secretary Standard
E0037 EP Training Program Standard
K0291 Emergency Lighting Standard
K0293 Exit Signage Standard
K0781 Portable Space Heaters Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard