S&C QCOR RHC 2567s
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RHCs 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 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
▼ 153883 Foundations Family Medicine Pc 25 W Main Street Austin IN 5 (Chicago) 08/07/2019 M2Z911 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0040 Physical Plant And Environment Condition
J0160 Program Evaluation Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0030 Names And Contact Information Standard
J0042 Physical Plant And Environment Standard
J0043 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
J0125 Provision Of Services Standard
J0136 Provision Of Services Standard
J0152 Patient Health Records Standard
▼ 153887 St Vincent Medical Group Inc 301 N Henry St North Vernon IN 5 (Chicago) 03/03/2020 IEG211 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0044 Physical Plant And Environment Standard
J0123 Staffing And Staff Responsibilities Standard
J0124 Provision Of Services Standard
J0125 Provision Of Services Standard
▼ 153890 Montgomery Medical Associates Llc 542 N 3rd St Montgomery IN 5 (Chicago) 11/08/2024 G8UB11 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
E0007 Ep Program Patient Population Standard
E0039 Ep Testing Requirements Standard
J0011 Compliance With Fed., State & Local Laws Standard
J0042 Physical Plant And Environment Standard
J0100 Staffing And Staff Responsibilities Standard
J0151 Patient Health Records Standard
J0152 Patient Health Records Standard
▼ 153890 Montgomery Medical Associates Llc 542 N 3rd St Montgomery IN 5 (Chicago) 12/10/2018 U9RJ12 Standard
Deficiency Tag Deficiency Description Tag Type
E0024 Policies/Procedures-Volunteers And Staffing Standard
▼ 153890 Montgomery Medical Associates Llc 542 N 3rd St Montgomery IN 5 (Chicago) 09/25/2018 U9RJ11 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
J0019 Physical Plant And Environment Condition
J0076 Program Evaluation Condition
J0080 Staffing And Staff Responsibilities Condition
J0023 Location Of Clinic Standard
J0053 Basic Requirements Standard
J0054 Patient Care Policies Standard
J0055 Patient Care Policies Standard
J0077 Annual Total Program Evaluation Standard
J0078 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
▼ 153896 Reid Primary & Specialty Care 1154 South State Road 1 Cambridge City IN 5 (Chicago) 04/22/2025 CHMG11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0043 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
J0136 Provision Of Services Standard
▼ 153896 Reid Primary & Specialty Care 1154 South State Road 1 Cambridge City IN 5 (Chicago) 04/05/2019 GP1L11 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
J0043 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
J0125 Provision Of Services Standard
J0152 Patient Health Records Standard
▼ 153897 St Vincent Medical Group Inc 301 Henry St Bldg B North Vernon IN 5 (Chicago) 08/08/2019 LU7S11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0043 Physical Plant And Environment Standard
▼ 153904 Good Samaritan Hospital Physician Services Inc 611 East Main Street, Ste 110 Petersburg IN 5 (Chicago) 08/06/2019 7EEI11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0044 Physical Plant And Environment Standard
▼ 153922 Fast Pace Medical Clinic Pllc 1732 West North Street Kendallville IN 5 (Chicago) 10/01/2024 VUM411 Complaint
Deficiency Tag Deficiency Description Tag Type
J0000 Initial Comments - Not A Deficiency Citation Memo
J0123 Staffing And Staff Responsibilities Standard
J0124 Provision Of Services Standard
J0135 Provision Of Services Standard