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GS*HS*10000*10000*251003*1610*1487113239*X*005010X279A1~
ST*270*000033257*005010X279A1~
BHT*0022*13*000033257*2510276*1610~
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NM1*PR*2*MEDICARE PPS*****PI*10000~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
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NM1*IL*1*DICKENS*EDDIE****MI*1D83WP1JW83~
DMG*D8*19510717*M~
DTP*291*RD8*20251003-20260101~
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IEA*1*000033257~