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
▼ 15C0001129 The Carmel Physicians Surgery Center Llc 13421 Old Meridian St Carmel IN 5 (Chicago) 06/12/2023 5F98B-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0353 Sprinkler System - Maintenance and Testing Standard
K0754 Soiled Linen and Trash Containers Standard
▼ 15C0001129 The Carmel Physicians Surgery Center Llc 13421 Old Meridian St Carmel IN 5 (Chicago) 09/09/2019 KDRE21 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
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
K0131 Multiple Occupancies Standard
K0712 Fire Drills Standard
K0913 Electrical Systems - Wet Procedure Locations Standard
K0915 Essential Electrical Systems ? Type 1 and Type 2 Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0933 Features of Fire Protection ? Fire Loss Prevention Standard
▼ 15C0001129 The Carmel Physicians Surgery Center Llc 13421 Old Meridian St Carmel IN 5 (Chicago) 07/25/2019 KDRE11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0041 CONTRACT SERVICES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0108 BUILDING SAFETY Standard
▼ 15C0001130 Endoscopy Center Llc 13421 Old Meridian St Ste 150 Carmel IN 5 (Chicago) 06/12/2023 5F87E-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0754 Soiled Linen and Trash Containers Standard
▼ 15C0001130 Endoscopy Center Llc 13421 Old Meridian St Ste 150 Carmel IN 5 (Chicago) 08/12/2019 PDKY21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 15C0001130 Endoscopy Center Llc 13421 Old Meridian St Ste 150 Carmel IN 5 (Chicago) 07/23/2019 PDKY11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0041 CONTRACT SERVICES Standard
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0184 VERBAL ORDERS Standard
▼ 15C0001133 Sullivan Surgicenter Llc 320 N Section St Sullivan IN 5 (Chicago) 11/21/2023 617E7-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE Standard
Q0108 BUILDING SAFETY Standard
Q0122 REAPPRAISALS Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0243 INFECTION CONTROL PROGRAM - DIRECTION Standard
▼ 15C0001133 Sullivan Surgicenter Llc 320 N Section St Sullivan IN 5 (Chicago) 11/21/2023 617E7-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
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
K0291 Emergency Lighting Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0355 Portable Fire Extinguishers Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0916 Essential Electrical Systems ? Alarm Annunciator Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 15C0001133 Sullivan Surgicenter Llc 320 N Section St Sullivan IN 5 (Chicago) 02/04/2020 OBPD21 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
E0006 Plan Based on All Hazards Risk Assessment Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development of EP Policies and Procedures Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0029 Development of Communication Plan Standard
E0031 Emergency Officials Contact Information Standard
E0036 EP Training and Testing Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
K0291 Emergency Lighting Standard
K0311 Vertical Openings - Enclosure Standard
K0321 Hazardous Areas - Enclosure Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0355 Portable Fire Extinguishers Standard
K0511 Utilities - Gas and Electric Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0916 Essential Electrical Systems ? Alarm Annunciator Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 15C0001133 Sullivan Surgicenter Llc 320 N Section St Sullivan IN 5 (Chicago) 01/30/2020 OBPD11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0083 PERFORMANCE IMPROVEMENT PROJECTS Standard
Q0084 GOVERNING BODY RESPONSIBILITIES Standard
Q0104 SAFETY FROM FIRE Standard
Q0107 DOORS TO HAZARDOUS AREAS Standard
Q0108 BUILDING SAFETY Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0122 REAPPRAISALS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard