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GS*HS*10000*10000*250813*1508*1487113239*X*005010X279A1~
ST*270*000030874*005010X279A1~
BHT*0022*13*000030874*2508225*1508~
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*SANCHEZ*DOROTHY****MI*6E72C60YN06~
DMG*D8*19380801*F~
DTP*291*RD8*20250813-20251111~
EQ*42~
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SE*14*000030874~
GE*1*30874~
IEA*1*000030874~