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
52C0001030 Madison Surgery Center 1 S Park St 3rd Flr Madison WI 5 (Chicago) 08/27/2018 QQRQ21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0311 Vertical Openings - Enclosure Standard
K0323 Anesthetizing Locations 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
K0754 Soiled Linen and Trash Containers Standard
K0911 Electrical Systems - Other Standard
52C0001034 Ambulatory Surgical Ctr Llc 2120 S Washburn St Oshkosh WI 5 (Chicago) 06/05/2025 664E0-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0242 INFECTION CONTROL PROGRAM Standard
52C0001034 Ambulatory Surgical Ctr Llc 2120 S Washburn St Oshkosh WI 5 (Chicago) 06/04/2025 664E0-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0341 Fire Alarm System - Installation Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0521 HVAC Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
52C0001035 Froedtert Health West Bend Surgery Center 3212 Pleasant Valley Road West Bend WI 5 (Chicago) 07/23/2019 YB5111 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0062 ANESTHETIC - DISCHARGE Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0266 DISCHARGE - ORDER Standard
52C0001035 Froedtert Health West Bend Surgery Center 3212 Pleasant Valley Road West Bend WI 5 (Chicago) 07/23/2019 YB5121 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
K0712 Fire Drills Standard
52C0001039 Wisconsin Laser And Surgery Center 10200 W Innovation Dr Suite 700 Milwaukee WI 5 (Chicago) 04/03/2018 8H4S11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0061 ANESTHETIC RISK AND EVALUATION Standard
Q0104 SAFETY FROM FIRE Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
52C0001039 Wisconsin Laser And Surgery Center 10200 W Innovation Dr Suite 700 Milwaukee WI 5 (Chicago) 04/02/2018 8H4S21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0353 Sprinkler System - Maintenance and Testing Standard
52C0001043 Novamed Surgery Center Of Madison 1200 John Q Hammons Dr Ste 102 Madison WI 5 (Chicago) 09/11/2024 64181-H1 Focused Infection Control, Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
52C0001043 Novamed Surgery Center Of Madison 1200 John Q Hammons Dr Ste 102 Madison WI 5 (Chicago) 09/11/2024 64181-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0223 Doors with Self-Closing Devices Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0911 Electrical Systems - Other Standard
K0912 Electrical Systems - Receptacles Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
52C0001044 The Center For Aesthetic And Plastic Surgery Sc 425 S Commercial St Neenah WI 5 (Chicago) 02/12/2018 PWM911 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE Standard