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GS*HS*10000*10000*250807*1808*1487113239*X*005010X279A1~
ST*270*000030246*005010X279A1~
BHT*0022*13*000030246*2508219*1808~
HL*1**20*1~
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*DAVIS*LARRY****MI*6RW2HH8UQ08~
DMG*D8*19491228*M~
DTP*291*RD8*20250807-20251105~
EQ*42~
EQ*30~
SE*14*000030246~
GE*1*30246~
IEA*1*000030246~