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
▼ 50C0001218 Proliance Surgeons Inc, P.S 12911 120th Avenue Ne, Bldg H Kirkland WA 10 (Seattle) 07/07/2022 4EB1D-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
E0022 Policies/Procedures for Sheltering in Place Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0029 Development of Communication Plan Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
Q0002 DEFINITIONS Standard
Q0062 ANESTHETIC - DISCHARGE Standard
Q0104 SAFETY FROM FIRE Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0204 RADIOLOGIC SERVICES Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0266 DISCHARGE - ORDER Standard
▼ 50C0001218 Proliance Surgeons Inc, P.S 12911 120th Avenue Ne, Bldg H Kirkland WA 10 (Seattle) 07/07/2022 4EB1D-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
▼ 50C0001219 Fasa Family Wellness Pllc 1610 Bishop Rd Sw Ste 101 Tumwater WA 10 (Seattle) 11/07/2024 64768-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 50C0001219 Fasa Family Wellness Pllc 1610 Bishop Rd Sw Ste 101 Tumwater WA 10 (Seattle) 11/06/2024 64768-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0293 Exit Signage Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
▼ 50C0001219 Fasa Family Wellness Pllc 1610 Bishop Rd Sw Ste 101 Tumwater WA 10 (Seattle) 08/10/2020 60PK11 Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
E0007 EP Program Patient Population Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0245 INFECTION CONTROL PROGRAM Standard
▼ 50C0001219 Fasa Family Wellness Pllc 1610 Bishop Rd Sw Ste 101 Tumwater WA 10 (Seattle) 02/22/2018 0S2E21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0100 General Requirements - Other Standard
K0293 Exit Signage Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
▼ 50C0001220 Edmonds Asc Llc Dba Proliance Surgeons Inc /Edmonds Ctr For Opt Surgery 7320 216th Avenue Sw, Suite 140 Edmonds WA 10 (Seattle) 03/12/2024 62643-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0240 INFECTION CONTROL Condition
E0036 EP Training and Testing Standard
Q0104 SAFETY FROM FIRE Standard
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0122 REAPPRAISALS Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0265 DISCHARGE - SUPPLIES AND INFORMATION Standard
▼ 50C0001220 Edmonds Asc Llc Dba Proliance Surgeons Inc /Edmonds Ctr For Opt Surgery 7320 216th Avenue Sw, Suite 140 Edmonds WA 10 (Seattle) 03/12/2024 62643-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0511 Utilities - Gas and Electric Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0921 Electrical Equipment ? Testing and Maintenance Requirements Standard
▼ 50C0001220 Edmonds Asc Llc Dba Proliance Surgeons Inc /Edmonds Ctr For Opt Surgery 7320 216th Avenue Sw, Suite 140 Edmonds WA 10 (Seattle) 08/27/2019 13B011 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
E0007 EP Program Patient Population Standard
E0020 Policies for Evac. and Primary/Alt. Comm. Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
Q0062 ANESTHETIC - DISCHARGE Standard
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0232 SAFETY Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 50C0001220 Edmonds Asc Llc Dba Proliance Surgeons Inc /Edmonds Ctr For Opt Surgery 7320 216th Avenue Sw, Suite 140 Edmonds WA 10 (Seattle) 08/27/2019 13B021 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0345 Fire Alarm System - Testing and Maintenance Standard