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GS*HS*10000*10000*250922*1709*1487113239*X*005010X279A1~
ST*270*000032768*005010X279A1~
BHT*0022*13*000032768*2509265*1709~
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*JOLIBOIS*JOSEPH****MI*4TE2JT8UW09~
DMG*D8*19590819*M~
DTP*291*RD8*20250922-20251221~
EQ*42~
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SE*14*000032768~
GE*1*32768~
IEA*1*000032768~