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
15C0001166 Ball Outpatient Surgery Center Llc 2401 W University Ave Ste 200 Omp Muncie IN 5 (Chicago) 01/04/2019 HZ6H21 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
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
15C0001166 Ball Outpatient Surgery Center Llc 2401 W University Ave Ste 200 Omp Muncie IN 5 (Chicago) 12/19/2018 HZ6H11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0041 CONTRACT SERVICES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0223 NOTICE - PHYSICIAN OWNERSHIP Standard
Q0226 GRIEVANCES - MISTREATMENT, ABUSE Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
15C0001169 Bloomington Asc Llc 1380 W Arch Haven Ave Bloomington IN 5 (Chicago) 09/09/2025 1D4F0B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE Standard
Q0221 NOTICE OF RIGHTS Standard
Q0223 NOTICE - PHYSICIAN OWNERSHIP Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0241 SANITARY ENVIRONMENT Standard
15C0001169 Bloomington Asc Llc 1380 W Arch Haven Ave Bloomington IN 5 (Chicago) 09/09/2025 1D4F0B-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
15C0001169 Bloomington Asc Llc 1380 W Arch Haven Ave Bloomington IN 5 (Chicago) 01/19/2022 9TPE11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
15C0001169 Bloomington Asc Llc 1380 W Arch Haven Ave Bloomington IN 5 (Chicago) 01/19/2022 9TPE21 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
K0353 Sprinkler System - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
15C0001169 Bloomington Asc Llc 1380 W Arch Haven Ave Bloomington IN 5 (Chicago) 05/11/2018 8SWT21 Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0039 EP Testing Requirements Standard
K0331 Interior Wall and Ceiling Finish Standard
K0346 Fire Alarm System - Out of Service Standard
K0354 Sprinkler System - Out of Service Standard
15C0001169 Bloomington Asc Llc 1380 W Arch Haven Ave Bloomington IN 5 (Chicago) 04/11/2018 8SWT11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
15C0001171 Eye Care Surgery Center Of Evansville Llc 6540 Logan Drive, Suite #3 Evansville IN 5 (Chicago) 10/04/2018 SQ1G21 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
K0345 Fire Alarm System - Testing and Maintenance Standard
K0511 Utilities - Gas and Electric Standard
K0712 Fire Drills Standard
15C0001171 Eye Care Surgery Center Of Evansville Llc 6540 Logan Drive, Suite #3 Evansville IN 5 (Chicago) 09/14/2018 SQ1G11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0041 CONTRACT SERVICES Standard
Q0084 GOVERNING BODY RESPONSIBILITIES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard