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
▼ 158503 Grand Avenue Pediatrics 1402 Grand Ave Washington IN 5 (Chicago) 09/24/2018 EGD311 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0042 Integrated Ep Program Standard
J0008 Basic Requirements Standard
J0053 Basic Requirements Standard
J0055 Patient Care Policies Standard
J0062 Organizational Structure Standard
▼ 158506 Daviess Martin Medical Clinic 12546 E Us Hwy 50 Loogootee IN 5 (Chicago) 09/08/2023 9E6W11 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
▼ 158508 Loogootee Family Medicine 105 Cooper Street Loogootee IN 5 (Chicago) 11/01/2024 O8RD11 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
▼ 158508 Loogootee Family Medicine 105 Cooper Street Loogootee IN 5 (Chicago) 10/10/2018 BVCW11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0022 Location Of Clinic Standard
J0023 Location Of Clinic Standard
J0053 Basic Requirements Standard
J0055 Patient Care Policies Standard
▼ 158511 Osgood Primary Care 112 N Buckeye Street Osgood IN 5 (Chicago) 09/17/2020 3ZRT11 Special, 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
▼ 158530 Cameron Family Medicine 1500 W Maumee Street Angola IN 5 (Chicago) 08/13/2019 0KRO11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
▼ 158540 Family Practice Associates Of Sullivan County 2229 Mary Sherman Dr Sullivan IN 5 (Chicago) 05/07/2021 315Z11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0125 Provision Of Services Standard
J0152 Patient Health Records Standard
▼ 158559 Adams Medical Group - Berne 1521 W Main St Berne IN 5 (Chicago) 09/26/2019 5SK311 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
J0125 Provision Of Services Standard
▼ 163400 Wall Lake Medical Clinic 311 West First Street Wall Lake IA 7 (Kansas City) 09/01/2022 4CE711 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0080 Staffing And Staff Responsibilities Condition
J0100 Staffing And Staff Responsibilities Standard
J0101 Staffing And Staff Responsibilities Standard
▼ 163400 Wall Lake Medical Clinic 311 West First Street Wall Lake IA 7 (Kansas City) 08/01/2019 UC8911 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
J0080 Staffing And Staff Responsibilities Condition
J0120 Provision Of Services Condition
J0150 Patient Health Records Condition
J0160 Program Evaluation Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
E0029 Development Of Communication Plan Standard
E0031 Emergency Officials Contact Information Standard
E0036 Ep Training And Testing Standard
E0039 Ep Testing Requirements Standard
J0043 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
J0085 Staffing And Staff Responsibilities Standard
J0100 Staffing And Staff Responsibilities Standard
J0125 Provision Of Services Standard
J0152 Patient Health Records Standard
J0153 Patient Health Records Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard