If a hospital, ambulatory surgical center, or portable x-ray supplier is undergoing a change of ownership (CHOW), in accordance with the principles outlined in 42 CFR 489.18, the entity must submit a new CMS-855 application for the new ownership.

Changing Medicare Information
Medicare Identification Number (if issued): NPI —Go to Section 1B.

Change of Ownership
(Applicable to hospitals, portable x-ray suppliers, and ambulatory surgical centers only.)
Complete all sections and provide a copy of the sales agreement.