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
24C0001060 Centracare Surgery Ctr Llc 1900 Centracare Circle Saint Cloud MN 5 (Chicago) 07/17/2019 V4KY11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
Q0264 POST-SURGICAL ASSESSMENT Standard
24C0001060 Centracare Surgery Ctr Llc 1900 Centracare Circle Saint Cloud MN 5 (Chicago) 07/16/2019 V4KY21 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0712 Fire Drills Standard
24C0001063 North Memorial Ambulatory Surgery Center At Maple Grove Llc 9855 Hospital Drive 1st Floor #175 Maple Grove MN 5 (Chicago) 08/20/2025 1D0E34-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0242 INFECTION CONTROL PROGRAM Standard
24C0001063 North Memorial Ambulatory Surgery Center At Maple Grove Llc 9855 Hospital Drive 1st Floor #175 Maple Grove MN 5 (Chicago) 08/19/2025 1D0E34-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0511 Utilities - Gas and Electric Standard
K0521 HVAC Standard
K0712 Fire Drills Standard
K0901 Fundamentals - Building System Categories Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
24C0001063 North Memorial Ambulatory Surgery Center At Maple Grove Llc 9855 Hospital Drive 1st Floor #175 Maple Grove MN 5 (Chicago) 04/11/2018 2RDF11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0242 INFECTION CONTROL PROGRAM Standard
24C0001069 Southwest Minnesota Surgical Center, Inc. 1401 Nwakama Street Marshall MN 5 (Chicago) 12/06/2018 2J0111 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0039 EP Testing Requirements Standard
Q0041 CONTRACT SERVICES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0161 ORGANIZATION Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0220 NOTICE - POSTING Standard
Q0221 NOTICE OF RIGHTS Standard
Q0241 SANITARY ENVIRONMENT Standard
24C0001070 North Metro Surgery Center 11855 Ulysses Street, Suite 270 Blaine MN 5 (Chicago) 09/10/2019 ND2921 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
24C0001071 Minnesota Eye Laser & Surgery Centers Llc 11091 Ulysses Street Suite #400 Blaine MN 5 (Chicago) 02/23/2018 ERSE11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0104 SAFETY FROM FIRE Standard
24C0001071 Minnesota Eye Laser & Surgery Centers Llc 11091 Ulysses Street Suite #400 Blaine MN 5 (Chicago) 02/23/2018 ERSE21 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0754 Soiled Linen and Trash Containers Standard
24C0001079 Center For Pain Management Ambulatory Surgery, Ltd. 519 22nd Avenue East Alexandria MN 5 (Chicago) 07/09/2025 6665E-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0345 Fire Alarm System - Testing and Maintenance Standard
K0351 Sprinkler System - Installation Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard