| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 52P002 | (X3) Date Survey Completed 03/24/2022 |
| Name of Provider or Supplier Versiti Wisconsin | Street Address, City, State 638 North 18th Street, Milwaukee, WI | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| Z0000 | An unannounced recertification survey was conducted by a Federal survey team at Versiti Wisconsin, Inc. in Milwaukee, Wisconsin on March 21-24, 2022. The supplier was found to be in compliance with the requirements for participation in Medicare at 42 CFR 486, Subpart for Organ Procurement Organizations |