S&C QCOR RHC 2567s
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RHCs 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 RHC 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
▼ 443961 Kingston Family Practice, Pc 820 West Race Street Kingston TN 4 (Atlanta) 10/17/2018 6CMG11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0004 Develop Ep Plan, Review And Update Annually Standard
J0042 Physical Plant And Environment Standard
J0123 Staffing And Staff Responsibilities Standard
J0136 Provision Of Services Standard
J0161 Program Evaluation Standard
▼ 443967 Pioneer Pediatrics Pllc 236 E Main St Mc Minnville TN 4 (Atlanta) 12/13/2021 RCOH11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0001 Establishment Of The Emergency Program (Ep) Condition
J0160 Program Evaluation Condition
J0041 Physical Plant And Environment Standard
J0123 Staffing And Staff Responsibilities Standard
J0161 Program Evaluation Standard
▼ 443970 Springer Medical Associates 16615 Highway 104 N Suite B Lexington TN 4 (Atlanta) 03/20/2024 9NS711 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0001 Establishment Of The Emergency Program (Ep) Condition
J0160 Program Evaluation Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0006 Plan Based On All Hazards Risk Assessment Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
E0036 Ep Training And Testing Standard
E0037 Ep Training Program Standard
E0039 Ep Testing Requirements Standard
J0123 Staffing And Staff Responsibilities Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard
▼ 443973 Kidzcare Pediatrics 119 Epperson Street Athens TN 4 (Atlanta) 05/23/2022 FROM11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0041 Physical Plant And Environment Standard
▼ 443974 Liberty Medical Clinic 4937 College Street Bells TN 4 (Atlanta) 05/29/2024 BL2011 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0001 Establishment Of The Emergency Program (Ep) Condition
J0160 Program Evaluation Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0006 Plan Based On All Hazards Risk Assessment Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
E0029 Development Of Communication Plan Standard
E0030 Names And Contact Information Standard
E0042 Integrated Ep Program Standard
J0041 Physical Plant And Environment Standard
J0042 Physical Plant And Environment Standard
J0043 Physical Plant And Environment Standard
J0062 Organizational Structure Standard
J0122 Provision Of Services Standard
J0123 Staffing And Staff Responsibilities Standard
J0124 Provision Of Services Standard
J0125 Provision Of Services Standard
J0136 Provision Of Services Standard
J0151 Patient Health Records Standard
J0153 Patient Health Records Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard
▼ 448908 Lentz Pediatrics Plc 10777 Hwy 412 West Lexington TN 4 (Atlanta) 06/11/2024 LMNU11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0001 Establishment Of The Emergency Program (Ep) Condition
J0160 Program Evaluation Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0006 Plan Based On All Hazards Risk Assessment Standard
E0036 Ep Training And Testing Standard
E0037 Ep Training Program Standard
J0123 Staffing And Staff Responsibilities Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard
▼ 448913 Reelfoot Family Walk- In Clinic 1516 East Reelfoot Avenue Union City TN 4 (Atlanta) 04/02/2018 RF1X11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0076 Program Evaluation Condition
J0080 Staffing And Staff Responsibilities Condition
E0036 Ep Training And Testing Standard
E0039 Ep Testing Requirements Standard
J0077 Annual Total Program Evaluation Standard
J0078 Evaluation Review Criteria Standard
J0079 Evaluation Review Criteria Standard
J0081 Staffing And Staff Responsibilities Standard
J0082 Staffing And Staff Responsibilities Standard
J0083 Staffing And Staff Responsibilities Standard
J0084 Staffing And Staff Responsibilities Standard
J0085 Staffing And Staff Responsibilities Standard
J0086 Staffing And Staff Responsibilities Standard
▼ 448914 Dover Medical Clinic 133 Dr Robert H Lee Drive Dover TN 4 (Atlanta) 04/23/2024 XGU911 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0001 Establishment Of The Emergency Program (Ep) Condition
J0150 Patient Health Records Condition
J0160 Program Evaluation Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0006 Plan Based On All Hazards Risk Assessment Standard
E0013 Development Of Ep Policies And Procedures Standard
E0022 Policies/Procedures For Sheltering In Place Standard
E0023 Policies/Procedures For Medical Documentation Standard
E0024 Policies/Procedures-Volunteers And Staffing Standard
E0030 Names And Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means For Communication Standard
E0033 Methods For Sharing Information Standard
E0036 Ep Training And Testing Standard
E0037 Ep Training Program Standard
E0039 Ep Testing Requirements Standard
E0042 Integrated Ep Program Standard
J0123 Staffing And Staff Responsibilities Standard
J0124 Provision Of Services Standard
J0125 Provision Of Services Standard
J0151 Patient Health Records Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard
▼ 448914 Dover Medical Clinic 133 Dr Robert H Lee Drive Dover TN 4 (Atlanta) 06/06/2018 V0G911 Standard
Deficiency Tag Deficiency Description Tag Type
E0004 Develop Ep Plan, Review And Update Annually Standard
E0006 Plan Based On All Hazards Risk Assessment Standard
E0007 Ep Program Patient Population Standard
E0022 Policies/Procedures For Sheltering In Place Standard
E0024 Policies/Procedures-Volunteers And Staffing Standard
E0029 Development Of Communication Plan Standard
E0032 Primary/Alternate Means For Communication Standard
E0034 Information On Occupancy/Needs Standard
E0036 Ep Training And Testing Standard
E0037 Ep Training Program Standard
E0039 Ep Testing Requirements Standard
J0022 Location Of Clinic Standard
▼ 448916 Terrell Clinic Llc 701 East Reelfoot Ave Suite 100 Union City TN 4 (Atlanta) 01/22/2025 RTXT11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0042 Physical Plant And Environment Standard
J0125 Provision Of Services Standard
J0136 Provision Of Services Standard