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
▼ 52C0001089 Orthopedic Surgery Center Of Green Bay Llc 2223 Lime Kiln Rd Ste 2 Green Bay WI 5 (Chicago) 10/03/2018 FW6411 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE 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) 10/03/2018 FW6421 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
K0372 Subdivision of Building Spaces ? Smoke Barrier Construction Standard
▼ 52C0001090 Alexander Eye Surgery Center 250 North Metro Drive Appleton WI 5 (Chicago) 09/11/2019 44W711 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0042 HOSPITALIZATION Standard
Q0104 SAFETY FROM FIRE Standard
Q0107 DOORS TO HAZARDOUS AREAS Standard
Q0122 REAPPRAISALS Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0221 NOTICE OF RIGHTS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0245 INFECTION CONTROL PROGRAM Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
▼ 52C0001090 Alexander Eye Surgery Center 250 North Metro Drive Appleton WI 5 (Chicago) 09/11/2019 44W721 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
E0036 EP Training and Testing Standard
E0039 EP Testing Requirements Standard
K0161 Building Construction Type and Height Standard
K0321 Hazardous Areas - Enclosure 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
K0712 Fire Drills Standard
K0903 Gas and Vacuum Piped Systems - Categories Standard
K0907 Gas and Vacuum Piped Systems ? Central Supply System Location Standard
K0908 Gas and Vacuum Piped Systems ? Central Supply System Alarms Standard
▼ 52C0001093 Independent Surgery Center 2751 Commercial Blvd Ste 7 Chippewa Falls WI 5 (Chicago) 03/03/2020 XWZM11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
▼ 52C0001093 Independent Surgery Center 2751 Commercial Blvd Ste 7 Chippewa Falls WI 5 (Chicago) 03/03/2020 XWZM21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0521 HVAC Standard
K0908 Gas and Vacuum Piped Systems ? Central Supply System Alarms Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 52C0001100 Pain Centers Of Wisconsin Wauwatosa 959 N Mayfair Rd Suite 100 Wauwatosa WI 5 (Chicago) 01/25/2019 FGXT11 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0060 SURGICAL SERVICES Condition
Q0100 ENVIRONMENT Condition
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0104 SAFETY FROM FIRE Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 52C0001100 Pain Centers Of Wisconsin Wauwatosa 959 N Mayfair Rd Suite 100 Wauwatosa WI 5 (Chicago) 01/25/2019 FGXT21 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0271 Discharge from Exits Standard
K0341 Fire Alarm System - Installation Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0919 Electrical Equipment - Other Standard
▼ 52C0001101 Ec Laser And Surgery Institute Of Wi 800 North First St Suite 100 Wausau WI 5 (Chicago) 08/20/2019 8WBN21 Recertification
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
K0341 Fire Alarm System - Installation Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 52C0001109 Wisconsin Specialty Surgery Center Llc 7401 104th Ave, Suite 100 Kenosha WI 5 (Chicago) 01/04/2018 3JYK11 Recertification, Sample Validation
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
Q0062 ANESTHETIC - DISCHARGE Standard
Q0101 PHYSICIAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0262 PRE-SURGICAL ASSESSMENT Standard
Q0266 DISCHARGE - ORDER Standard