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GS*HS*10000*10000*250901*1509*1487113239*X*005010X279A1~
ST*270*000031481*005010X279A1~
BHT*0022*13*000031481*2509244*1509~
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*SKIDMORE*JOHN****MI*5Q43YG0AU60~
DMG*D8*19540518*M~
DTP*291*RD8*20250901-20251130~
EQ*42~
EQ*30~
SE*14*000031481~
GE*1*31481~
IEA*1*000031481~