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
▼ 15C0001069 Surgicare, Llc 2907 Mcintire Dr Ste C Bloomington IN 5 (Chicago) 08/12/2019 PXOI21 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
E0031 Emergency Officials Contact Information Standard
E0036 EP Training and Testing Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 15C0001069 Surgicare, Llc 2907 Mcintire Dr Ste C Bloomington IN 5 (Chicago) 08/07/2019 PXOI11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0041 CONTRACT SERVICES Standard
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0084 GOVERNING BODY RESPONSIBILITIES Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 15C0001070 Advanced Surgery Center Llc 1400 Teal Rd Ste 7 Lafayette IN 5 (Chicago) 06/03/2025 6643B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0101 PHYSICAL ENVIRONMENT Standard
▼ 15C0001070 Advanced Surgery Center Llc 1400 Teal Rd Ste 7 Lafayette IN 5 (Chicago) 06/03/2025 6643B-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
K0521 HVAC Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 15C0001070 Advanced Surgery Center Llc 1400 Teal Rd Ste 7 Lafayette IN 5 (Chicago) 09/08/2021 YMQR21 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
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0521 HVAC Standard
▼ 15C0001070 Advanced Surgery Center Llc 1400 Teal Rd Ste 7 Lafayette IN 5 (Chicago) 08/25/2021 YMQR11 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0041 CONTRACT SERVICES Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 15C0001071 The South Bend Indiana Endoscopy Asc Llc 53830 Generations Dr Ste A South Bend IN 5 (Chicago) 12/16/2024 64CA6-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
K0712 Fire Drills Standard
▼ 15C0001071 The South Bend Indiana Endoscopy Asc Llc 53830 Generations Dr Ste A South Bend IN 5 (Chicago) 02/22/2021 4YVU21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0511 Utilities - Gas and Electric Standard
▼ 15C0001071 The South Bend Indiana Endoscopy Asc Llc 53830 Generations Dr Ste A South Bend IN 5 (Chicago) 02/19/2021 4YVU11 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE Standard
▼ 15C0001073 Northern Indiana Ambulatory Surgery Center 500 Arcade Ave Ste 100 Elkhart IN 5 (Chicago) 07/17/2018 FNZH11 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0141 ORGANIZATION AND STAFFING Standard