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
▼ 15C0001190 Advanced Regional Surgery Center, Llc 360 Missouri Avenue 19a, Suite 102 Jeffersonville IN 5 (Chicago) 02/15/2018 XS0O21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0036 EP Training and Testing Standard
E0039 EP Testing Requirements Standard
K0346 Fire Alarm System - Out of Service Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0354 Sprinkler System - Out of Service Standard
▼ 15C0001190 Advanced Regional Surgery Center, Llc 360 Missouri Avenue 19a, Suite 102 Jeffersonville IN 5 (Chicago) 01/31/2018 XS0O11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0083 PERFORMANCE IMPROVEMENT PROJECTS Standard
Q0084 GOVERNING BODY RESPONSIBILITIES Standard
Q0104 SAFETY FROM FIRE Standard
Q0123 OTHER PRACTITIONERS Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0230 EXERCISE OF RIGHTS BY OTHERS Standard
▼ 15C0001191 Interventional Pain Management 208 Legacy Plaza West La Porte IN 5 (Chicago) 05/24/2018 F8Y611 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0101 PHYSICIAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
▼ 15C0001191 Interventional Pain Management 208 Legacy Plaza West La Porte IN 5 (Chicago) 05/23/2018 F8Y621 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0007 EP Program Patient Population Standard
E0018 Procedures for Tracking of Staff and Patients Standard
E0022 Policies/Procedures for Sheltering in Place Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0032 Primary/Alternate Means for Communication Standard
E0039 EP Testing Requirements Standard
K0131 Multiple Occupancies Standard
K0291 Emergency Lighting Standard
K0321 Hazardous Areas - Enclosure Standard
K0511 Utilities - Gas and Electric Standard
K0521 HVAC Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 15C0001192 Beltway Surgery Centers, Llc 8830 South Meridian Street, Ste 250 Indianapolis IN 5 (Chicago) 05/28/2025 66136-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
▼ 15C0001192 Beltway Surgery Centers, Llc 8830 South Meridian Street, Ste 250 Indianapolis IN 5 (Chicago) 10/26/2021 CSP311 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
Q0108 BUILDING SAFETY Standard
▼ 15C0001193 Michiana Surgery Center Llc 3212 Hickory Road, Suite A Mishawaka IN 5 (Chicago) 10/20/2021 9UR821 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0013 Development of EP Policies and Procedures Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0031 Emergency Officials Contact Information Standard
K0291 Emergency Lighting Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0346 Fire Alarm System - Out of Service Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0354 Sprinkler System - Out of Service Standard
K0372 Subdivision of Building Spaces ? Smoke Barrier Construction Standard
K0521 HVAC Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0902 Gas and Vacuum Piped Systems - Other Standard
▼ 15C0001193 Michiana Surgery Center Llc 3212 Hickory Road, Suite A Mishawaka IN 5 (Chicago) 09/29/2021 9UR811 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0084 GOVERNING BODY RESPONSIBILITIES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0108 BUILDING SAFETY Standard
Q0122 REAPPRAISALS Standard
Q0201 LABORATORY SERVICES Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
▼ 15C0001195 Interventional Pain Management-Hobart 201 Main Street Suite A Hobart IN 5 (Chicago) 02/22/2023 5EDA9-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0101 PHYSICAL ENVIRONMENT Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0162 FORM AND CONTENT OF RECORD Standard
▼ 15C0001195 Interventional Pain Management-Hobart 201 Main Street Suite A Hobart IN 5 (Chicago) 02/22/2023 5EDA9-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0037 EP Training Program Standard
K0345 Fire Alarm System - Testing and Maintenance Standard