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GS*HS*10000*10000*251007*1210*1487113239*X*005010X279A1~
ST*270*000033342*005010X279A1~
BHT*0022*13*000033342*2510280*1210~
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*THOMPSON*WILLIAM****MI*9TN2R49KM70~
DMG*D8*19360513*M~
DTP*291*RD8*20251007-20260105~
EQ*42~
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GE*1*33342~
IEA*1*000033342~