S&C QCOR CLIA 2567s
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CLIA 2567s
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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 CLIA 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).

CLIA ID and Facility Name

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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 Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 04D2025667 Mission Family Practice 2630 E Citizens Drive Fayetteville AR 01/26/2018 UG5C12 Standard
Deficiency Tag Deficiency Description Tag Type
D6063 LABORATORY TESTING PERSONNEL null
D6065 TESTING PERSONNEL QUALIFICATIONS null
D6066 TESTING PERSONNEL QUALIFICATIONS null
▼ 04D2025667 Mission Family Practice 2630 E Citizens Drive Fayetteville AR 06/12/2019 P78P11 Standard
Deficiency Tag Deficiency Description Tag Type
D6032 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6046 TECHNICAL CONSULTANT RESPONSIBILITIES Standard
▼ 04D2025667 Mission Family Practice 2630 E Citizens Drive Fayetteville AR 03/03/2022 4V4F11 Standard
Deficiency Tag Deficiency Description Tag Type
D5437 CALIBRATION AND CALIBRATION VERIFICATION Standard
D6032 LABORATORY DIRECTOR RESPONSIBILITIES Standard
▼ 04D2028520 Arkansas Dermatology 1075 Andrews Drive Conway Conway AR 06/17/2022 CNCT11 Standard
Deficiency Tag Deficiency Description Tag Type
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
▼ 04D2028584 Arkansas Dermatology 4261 Stockton Drive, Suite 200 North Little Rock AR 10/09/2019 MC4011 Standard
Deficiency Tag Deficiency Description Tag Type
D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE Standard
D6107 LABORATORY DIRECTOR RESPONSIBILITIES Standard
▼ 04D2028584 Arkansas Dermatology 4261 Stockton Drive, Suite 200 North Little Rock AR 06/15/2022 E7W411 Standard
Deficiency Tag Deficiency Description Tag Type
D6107 LABORATORY DIRECTOR RESPONSIBILITIES Standard
▼ 04D2030368 Nea Baptist Clinic-Dermatology 4910 Medical Blvd Jonesboro AR 06/15/2022 65KW11 Standard
Deficiency Tag Deficiency Description Tag Type
D5401 PROCEDURE MANUAL Standard
D5473 CONTROL PROCEDURES Standard
▼ 04D2030368 Nea Baptist Clinic-Dermatology 4910 Medical Blvd Jonesboro AR 02/12/2026 PPNW11 Standard
Deficiency Tag Deficiency Description Tag Type
D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5805 TEST REPORT Standard
▼ 04D2032677 Pocahontas Medical Clinic East 1601 Market Dr Pocahontas AR 03/03/2020 I75J11 Special
Deficiency Tag Deficiency Description Tag Type
D2016 SUCCESSFUL PARTICIPATION Condition
D2130 HEMATOLOGY Standard
D6000 MODERATE COMPLEXITY LABORATORY DIRECTOR Condition
D6019 LABORATORY DIRECTOR RESPONSIBILITIES Standard
▼ 04D2032677 Pocahontas Medical Clinic East 1601 Market Dr Pocahontas AR 11/19/2020 D0JQ11 Standard
Deficiency Tag Deficiency Description Tag Type
D5403 PROCEDURE MANUAL Standard