S&C QCOR ASC 2567s
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ASCs 2567s
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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
▼ 38C0001057 Mark A. Petroff, Md Pc 17720 Jean Way, Suite 100 Lake Oswego OR 10 (Seattle) 09/04/2024 6409D-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0018 Procedures for Tracking of Staff and Patients Standard
K0223 Doors with Self-Closing Devices Standard
K0341 Fire Alarm System - Installation Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
▼ 38C0001057 Mark A. Petroff, Md Pc 17720 Jean Way, Suite 100 Lake Oswego OR 10 (Seattle) 08/29/2024 6409D-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0060 SURGICAL SERVICES Condition
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
▼ 38C0001057 Mark A. Petroff, Md Pc 17720 Jean Way, Suite 100 Lake Oswego OR 10 (Seattle) 12/18/2019 TZ7R21 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
K0291 Emergency Lighting Standard
K0712 Fire Drills Standard
▼ 38C0001057 Mark A. Petroff, Md Pc 17720 Jean Way, Suite 100 Lake Oswego OR 10 (Seattle) 12/17/2019 TZ7R11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 38C0001058 Cascade Endoscopy Center, Llc 1007 Harlow Road, Suite 110 Springfield OR 10 (Seattle) 05/06/2025 65F76-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0372 Subdivision of Building Spaces ? Smoke Barrier Construction Standard
▼ 38C0001058 Cascade Endoscopy Center, Llc 1007 Harlow Road, Suite 110 Springfield OR 10 (Seattle) 04/07/2021 QEVO11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 38C0001058 Cascade Endoscopy Center, Llc 1007 Harlow Road, Suite 110 Springfield OR 10 (Seattle) 04/07/2021 QEVO21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0321 Hazardous Areas - Enclosure Standard
K0353 Sprinkler System - Maintenance and Testing Standard
▼ 38C0001059 Eye Health Eastside Surgery Center, Llc 12050 Se Stevens Road Happy Valley OR 10 (Seattle) 04/21/2022 HE7J21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development of EP Policies and Procedures Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0036 EP Training and Testing Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
K0300 Protection - Other Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0712 Fire Drills Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
▼ 38C0001059 Eye Health Eastside Surgery Center, Llc 12050 Se Stevens Road Happy Valley OR 10 (Seattle) 04/20/2022 HE7J11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0101 PHYSICAL ENVIRONMENT Standard
Q0181 ADMINISTRATION OF DRUGS Standard
▼ 38C0001060 Oregon Outpatient Surgery Center, Llc 7300 Sw Childs Road, Suite A Tigard OR 10 (Seattle) 03/28/2023 5F6DD-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
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard