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
▼ 15C0001219 Iu Health Southwest Fort Wayne Ambulatory Surgery Center, Llc 4105 Dicke Road Fort Wayne IN 5 (Chicago) 02/27/2025 65506-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE Standard
Q0107 DOORS TO HAZARDOUS AREAS Standard
▼ 15C0001219 Iu Health Southwest Fort Wayne Ambulatory Surgery Center, Llc 4105 Dicke Road Fort Wayne IN 5 (Chicago) 02/27/2025 65506-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0222 Egress Doors Standard
K0321 Hazardous Areas - Enclosure Standard
K0331 Interior Wall and Ceiling Finish Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
▼ 15C0002002 Goshen Health Surgery Center Llc 1605 Winsted Dr Goshen IN 5 (Chicago) 08/01/2022 4ED25-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0291 Emergency Lighting Standard
K0321 Hazardous Areas - Enclosure Standard
K0323 Anesthetizing Locations Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0374 Subdivision of Building Spaces ? Smoke Barrier Doors Standard
K0915 Essential Electrical Systems ? Type 1 and Type 2 Standard
▼ 15C0002002 Goshen Health Surgery Center Llc 1605 Winsted Dr Goshen IN 5 (Chicago) 06/15/2022 4ED25-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
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
▼ 16C0001003 C.J. Elmwood Partners L.P. 4405 Hamilton Boulevard Sioux City IA 7 (Kansas City) 09/04/2024 63E86-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0181 ADMINISTRATION OF DRUGS Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 16C0001003 C.J. Elmwood Partners L.P. 4405 Hamilton Boulevard Sioux City IA 7 (Kansas City) 09/03/2024 63E86-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0345 Fire Alarm System - Testing and Maintenance Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 16C0001003 C.J. Elmwood Partners L.P. 4405 Hamilton Boulevard Sioux City IA 7 (Kansas City) 09/18/2020 OXN221 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0346 Fire Alarm System - Out of Service Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 16C0001003 C.J. Elmwood Partners L.P. 4405 Hamilton Boulevard Sioux City IA 7 (Kansas City) 09/09/2020 OXN211 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0181 ADMINISTRATION OF DRUGS Standard
▼ 16C0001006 Iowa Endoscopy Center 1378 Nw 124th Street, Suite 100 Clive IA 7 (Kansas City) 09/17/2024 6408F-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0761 Maintenance, Inspection & Testing - Doors Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 16C0001006 Iowa Endoscopy Center 1378 Nw 124th Street, Suite 100 Clive IA 7 (Kansas City) 09/11/2024 6408F-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0101 PHYSICAL ENVIRONMENT Standard