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
▼ 15C0001058 The Endoscopy Center At St Francis Llc 8051 S Emerson Ave Ste 150 Indianapolis IN 5 (Chicago) 01/30/2020 153X21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0321 Hazardous Areas - Enclosure Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
▼ 15C0001058 The Endoscopy Center At St Francis Llc 8051 S Emerson Ave Ste 150 Indianapolis IN 5 (Chicago) 01/23/2020 153X11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0241 SANITARY ENVIRONMENT Standard
▼ 15C0001062 Northside Gastroenterology Endoscopy Center Llc 8424 Naab Road, Suite 3g Indianapolis IN 5 (Chicago) 12/19/2023 61A12-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
▼ 15C0001062 Northside Gastroenterology Endoscopy Center Llc 8424 Naab Road, Suite 3g Indianapolis IN 5 (Chicago) 02/06/2020 VW1U21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0712 Fire Drills Standard
K0906 Gas and Vacuum Piped Systems ? Central Supply System Operations Standard
K0907 Gas and Vacuum Piped Systems ? Central Supply System Location Standard
▼ 15C0001062 Northside Gastroenterology Endoscopy Center Llc 8424 Naab Road, Suite 3g Indianapolis IN 5 (Chicago) 01/08/2020 VW1U11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 15C0001065 Ent Realty Corp 7900 W Jefferson Boulevard, Suite 102 Fort Wayne IN 5 (Chicago) 01/30/2025 65146-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0039 EP Testing Requirements Standard
▼ 15C0001065 Ent Realty Corp 7900 W Jefferson Boulevard, Suite 102 Fort Wayne IN 5 (Chicago) 01/26/2021 GPSW21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0761 Maintenance, Inspection & Testing - Doors Standard
K0913 Electrical Systems - Wet Procedure Locations Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
▼ 15C0001065 Ent Realty Corp 7900 W Jefferson Boulevard, Suite 102 Fort Wayne IN 5 (Chicago) 01/14/2021 GPSW11 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
Q0232 SAFETY Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 15C0001069 Surgicare, Llc 2907 Mcintire Dr Ste C Bloomington IN 5 (Chicago) 07/20/2023 60433-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0083 PERFORMANCE IMPROVEMENT PROJECTS Standard
Q0104 SAFETY FROM FIRE Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0110 EMERGENCY PERSONNEL Standard
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0162 FORM AND CONTENT OF RECORD Standard
▼ 15C0001069 Surgicare, Llc 2907 Mcintire Dr Ste C Bloomington IN 5 (Chicago) 07/20/2023 60433-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0004 Develop EP Plan, Review and Update Annually Standard
E0013 Development of EP Policies and Procedures Standard
E0029 Development of Communication Plan Standard
E0036 EP Training and Testing Standard
K0353 Sprinkler System - Maintenance and Testing Standard