S&C QCOR ASC 2567s
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ASCs 2567s
Selection Criteria ▸

Time Interval

Please select the calendar year or years for which you would like data.

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
▼ 52C0001068 Ambulatory Surgical Center Of Stevens Point 500 Vincent St Ste A Stevens Point WI 5 (Chicago) 02/13/2019 J9VE21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0346 Fire Alarm System - Out of Service Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0354 Sprinkler System - Out of Service Standard
K0919 Electrical Equipment - Other Standard
▼ 52C0001070 Access Medical Center 4216 Old Green Bay Road Racine WI 5 (Chicago) 05/30/2018 0WPQ11 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
Q0240 INFECTION CONTROL Condition
Q0061 ANESTHETIC RISK AND EVALUATION Standard
Q0101 PHYSICIAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0105 EMERGENCY EQUIPMENT Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0221 NOTICE OF RIGHTS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0261 ADMISSION ASSESSMENT Standard
Q0262 PRE-SURGICAL ASSESSMENT Standard
▼ 52C0001070 Access Medical Center 4216 Old Green Bay Road Racine WI 5 (Chicago) 05/29/2018 0WPQ21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0712 Fire Drills Standard
▼ 52C0001074 The Orthopaedic Surgery Center Llc N15w28300 Golf Rd Pewaukee WI 5 (Chicago) 06/11/2019 PE7V21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0321 Hazardous Areas - Enclosure Standard
K0712 Fire Drills Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 52C0001083 Lake Country Endoscopy Center 1185 Corporate Center Dr Ste 125 Oconomowoc WI 5 (Chicago) 12/13/2018 FY9S11 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0062 ANESTHETIC - DISCHARGE Standard
Q0104 SAFETY FROM FIRE Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0221 NOTICE OF RIGHTS Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
Q0266 DISCHARGE - ORDER Standard
▼ 52C0001083 Lake Country Endoscopy Center 1185 Corporate Center Dr Ste 125 Oconomowoc WI 5 (Chicago) 12/13/2018 FY9S21 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0321 Hazardous Areas - Enclosure Standard
K0712 Fire Drills Standard
▼ 52C0001088 Pain Centers Of Wisconsin Franklin 4202 W Oakwood Park Court Franklin WI 5 (Chicago) 05/07/2019 CKSN11 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0100 ENVIRONMENT Condition
Q0084 GOVERNING BODY RESPONSIBILITIES Standard
Q0104 SAFETY FROM FIRE Standard
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 52C0001088 Pain Centers Of Wisconsin Franklin 4202 W Oakwood Park Court Franklin WI 5 (Chicago) 05/07/2019 CKSN21 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0521 HVAC Standard
▼ 52C0001089 Orthopedic Surgery Center Of Green Bay Llc 2223 Lime Kiln Rd Ste 2 Green Bay WI 5 (Chicago) 07/31/2025 1D197F-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0062 ANESTHETIC - DISCHARGE Standard
Q0104 SAFETY FROM FIRE Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
▼ 52C0001089 Orthopedic Surgery Center Of Green Bay Llc 2223 Lime Kiln Rd Ste 2 Green Bay WI 5 (Chicago) 07/31/2025 1D197F-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard