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GS*HS*10000*10000*250807*1608*1487113239*X*005010X279A1~
ST*270*000030561*005010X279A1~
BHT*0022*13*000030561*2508219*1608~
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NM1*PR*2*MEDICARE PPS*****PI*10000~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*SIMMS*ESPARILLA****MI*7FR3NX1GE75~
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DTP*291*RD8*20250807-20251105~
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IEA*1*000030561~