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
▼ 39C0001070 Main Line Surgery Center, Llc 10 Presidential Boulevard Suite 200 Bala Cynwyd PA 3 (Philadelphia) 01/20/2023 5E475-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0246 COVID-19 Vaccination of Facility Staff Standard
▼ 39C0001073 Sally K. Balin Ambulatory Surgical Center, P.C. 110 Chesley Drive Media PA 3 (Philadelphia) 04/18/2024 6205F-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0241 SANITARY ENVIRONMENT Standard
▼ 39C0001073 Sally K. Balin Ambulatory Surgical Center, P.C. 110 Chesley Drive Media PA 3 (Philadelphia) 01/08/2020 R5UO21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0004 Develop EP Plan, Review and Update Annually Standard
E0007 EP Program Patient Population Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0034 Information on Occupancy/Needs Standard
E0039 EP Testing Requirements Standard
K0131 Multiple Occupancies Standard
K0353 Sprinkler System - Maintenance and Testing Standard
▼ 39C0001074 Hazelton Ambulatory Surgical Center 1062 N Church Street Hazleton PA 3 (Philadelphia) 07/10/2018 C7GP21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0022 Policies/Procedures for Sheltering in Place Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
K0100 General Requirements - Other Standard
K0521 HVAC Standard
▼ 39C0001075 Indiana Ambulatory Surgical Associates Llc 841 Hospital Road Suite 1200 Indiana PA 3 (Philadelphia) 04/15/2025 65067-L1 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
E0039 EP Testing Requirements Standard
▼ 39C0001075 Indiana Ambulatory Surgical Associates Llc 841 Hospital Road Suite 1200 Indiana PA 3 (Philadelphia) 10/05/2021 HAA421 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0013 Development of EP Policies and Procedures Standard
K0293 Exit Signage Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0908 Gas and Vacuum Piped Systems ? Central Supply System Alarms Standard
K0911 Electrical Systems - Other Standard
K0912 Electrical Systems - Receptacles Standard
▼ 39C0001075 Indiana Ambulatory Surgical Associates Llc 841 Hospital Road Suite 1200 Indiana PA 3 (Philadelphia) 09/17/2018 2WVE11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0041 CONTRACT SERVICES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
▼ 39C0001075 Indiana Ambulatory Surgical Associates Llc 841 Hospital Road Suite 1200 Indiana PA 3 (Philadelphia) 09/17/2018 32SA11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0041 CONTRACT SERVICES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
▼ 39C0001075 Indiana Ambulatory Surgical Associates Llc 841 Hospital Road Suite 1200 Indiana PA 3 (Philadelphia) 09/12/2018 2WVE21 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
E0009 Local, State, Tribal Collaboration Process Standard
E0036 EP Training and Testing Standard
K0291 Emergency Lighting Standard
K0311 Vertical Openings - Enclosure Standard
K0374 Subdivision of Building Spaces ? Smoke Barrier Doors Standard
K0521 HVAC Standard
K0908 Gas and Vacuum Piped Systems ? Central Supply System Alarms Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0929 Gas Equipment ? Precautions for Handling Oxygen Standard
▼ 39C0001076 Philadelphia Surgicenter,Inc 9500 Roosevelt Boulevard Philadelphia PA 3 (Philadelphia) 05/03/2023 5FD9C-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard