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
▼ 50C0001244 Proliance Surgeons Inc Ps 2409 North 45th Street Seattle WA 10 (Seattle) 08/28/2019 WXW711 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0002 DEFINITIONS Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0122 REAPPRAISALS Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0229 EXERCISE OF RIGHTS - INFORMED CONSENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
Q0266 DISCHARGE - ORDER Standard
▼ 50C0001244 Proliance Surgeons Inc Ps 2409 North 45th Street Seattle WA 10 (Seattle) 08/28/2019 WXW721 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0321 Hazardous Areas - Enclosure Standard
K0341 Fire Alarm System - Installation Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0355 Portable Fire Extinguishers Standard
K0511 Utilities - Gas and Electric Standard
K0521 HVAC Standard
K0531 Elevators Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0908 Gas and Vacuum Piped Systems ? Central Supply System Alarms Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0915 Essential Electrical Systems ? Type 1 and Type 2 Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 50C0001246 Sam Naficy Md Ps Inc 1110 112th Avenue Ne Ste 150 Bellevue WA 10 (Seattle) 04/03/2025 65852-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0104 SAFETY FROM FIRE Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 50C0001246 Sam Naficy Md Ps Inc 1110 112th Avenue Ne Ste 150 Bellevue WA 10 (Seattle) 04/02/2025 65852-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0291 Emergency Lighting Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0521 HVAC Standard
K0712 Fire Drills Standard
K0915 Essential Electrical Systems ? Type 1 and Type 2 Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 50C0001246 Sam Naficy Md Ps Inc 1110 112th Avenue Ne Ste 150 Bellevue WA 10 (Seattle) 07/05/2022 K0O211 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0080 QUALITY ASSESSMENT AND PERFORMANCE Condition
Q0240 INFECTION CONTROL Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0018 Procedures for Tracking of Staff and Patients Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0034 Information on Occupancy/Needs Standard
E0036 EP Training and Testing Standard
Q0041 CONTRACT SERVICES Standard
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0122 REAPPRAISALS Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0225 SUBMISSION AND INVESTIGATION OF GRIEVANCES Standard
Q0229 EXERCISE OF RIGHTS - INFORMED CONSENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0243 INFECTION CONTROL PROGRAM - DIRECTION Standard
▼ 50C0001246 Sam Naficy Md Ps Inc 1110 112th Avenue Ne Ste 150 Bellevue WA 10 (Seattle) 07/05/2022 K0O221 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0291 Emergency Lighting Standard
K0323 Anesthetizing Locations Standard
K0331 Interior Wall and Ceiling Finish Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0346 Fire Alarm System - Out of Service Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0354 Sprinkler System - Out of Service Standard
K0372 Subdivision of Building Spaces ? Smoke Barrier Construction Standard
K0521 HVAC Standard
K0711 Evacuation and Relocation Plan Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0913 Electrical Systems - Wet Procedure Locations Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0915 Essential Electrical Systems ? Type 1 and Type 2 Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
K0921 Electrical Equipment ? Testing and Maintenance Requirements Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
K0926 Gas Equipment - Qualifications and Training Standard
K0933 Features of Fire Protection ? Fire Loss Prevention Standard
▼ 50C0001247 Evergreen Eye Center 1229 Madison Street #1250 Seattle WA 10 (Seattle) 03/11/2026 1E21D3-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
E0031 Emergency Officials Contact Information Standard
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0122 REAPPRAISALS Standard
Q0123 OTHER PRACTITIONERS Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0223 NOTICE - PHYSICIAN OWNERSHIP Standard
Q0227 RESPECT - PROPERTY & PERSON Standard
Q0230 EXERCISE OF RIGHTS BY OTHERS Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0243 INFECTION CONTROL PROGRAM - DIRECTION Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
Q0263 ADMISSION ASSESSMENT - RECORD Standard
▼ 50C0001247 Evergreen Eye Center 1229 Madison Street #1250 Seattle WA 10 (Seattle) 03/11/2026 1E21D3-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0291 Emergency Lighting Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0346 Fire Alarm System - Out of Service Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0354 Sprinkler System - Out of Service Standard
K0521 HVAC Standard
K0531 Elevators Standard
K0711 Evacuation and Relocation Plan Standard
K0712 Fire Drills Standard
K0741 Smoking Regulations Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 50C0001247 Evergreen Eye Center 1229 Madison Street #1250 Seattle WA 10 (Seattle) 10/13/2022 4F6EC-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0002 DEFINITIONS Standard
Q0061 ANESTHETIC RISK AND EVALUATION Standard
Q0062 ANESTHETIC - DISCHARGE Standard
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0104 SAFETY FROM FIRE Standard
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0246 COVID-19 Vaccination of Facility Staff Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
Q0264 POST-SURGICAL ASSESSMENT Standard
▼ 50C0001247 Evergreen Eye Center 1229 Madison Street #1250 Seattle WA 10 (Seattle) 10/13/2022 4F6EC-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0372 Subdivision of Building Spaces ? Smoke Barrier Construction Standard