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
15C0001116 Midwest Eye Consultants Pc 1601 W Lincoln Rd Kokomo IN 5 (Chicago) 05/16/2023 5FACE-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0023 Policies/Procedures for Medical Documentation Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0029 Development of Communication Plan Standard
E0036 EP Training and Testing Standard
E0037 EP Training Program Standard
K0223 Doors with Self-Closing Devices Standard
K0281 Illumination of Means of Egress Standard
K0291 Emergency Lighting Standard
K0321 Hazardous Areas - Enclosure Standard
K0323 Anesthetizing Locations Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
15C0001116 Midwest Eye Consultants Pc 1601 W Lincoln Rd Kokomo IN 5 (Chicago) 05/21/2019 1QHQ21 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
K0781 Portable Space Heaters Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
15C0001116 Midwest Eye Consultants Pc 1601 W Lincoln Rd Kokomo IN 5 (Chicago) 05/16/2019 1QHQ11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0224 ADVANCED DIRECTIVES Standard
15C0001120 Franciscan Surgery Center Llc 5255 E Stop 11 Road, Suite 100 Indianapolis IN 5 (Chicago) 06/09/2022 4ED1E-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0245 INFECTION CONTROL PROGRAM Standard
15C0001120 Franciscan Surgery Center Llc 5255 E Stop 11 Road, Suite 100 Indianapolis IN 5 (Chicago) 02/07/2022 CVW921 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0100 General Requirements - Other Standard
K0291 Emergency Lighting Standard
K0323 Anesthetizing Locations Standard
K0351 Sprinkler System - Installation Standard
K0521 HVAC Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0904 Gas and Vacuum Piped Systems ? Warning Systems Standard
K0907 Gas and Vacuum Piped Systems ? Central Supply System Location Standard
K0916 Essential Electrical Systems ? Alarm Annunciator Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
15C0001120 Franciscan Surgery Center Llc 5255 E Stop 11 Road, Suite 100 Indianapolis IN 5 (Chicago) 02/01/2022 CVW911 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
15C0001121 Summit Surgical Suites Llc 7920 W Jefferson Blvd Ste 210 Fort Wayne IN 5 (Chicago) 09/22/2022 4F307-H1 Focused Infection Control, Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE Standard
15C0001121 Summit Surgical Suites Llc 7920 W Jefferson Blvd Ste 210 Fort Wayne IN 5 (Chicago) 09/22/2022 4F307-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0291 Emergency Lighting Standard
15C0001122 Beltway Surgery Centers Llc 10300 N Illinois St Ste 2400 Carmel IN 5 (Chicago) 01/21/2026 1E0CA7-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
15C0001122 Beltway Surgery Centers Llc 10300 N Illinois St Ste 2400 Carmel IN 5 (Chicago) 01/21/2026 1E0CA7-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0300 Protection - Other Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0351 Sprinkler System - Installation Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0781 Portable Space Heaters Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard