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GS*HS*10000*10000*251013*1010*1487113239*X*005010X279A1~
ST*270*000034014*005010X279A1~
BHT*0022*13*000034014*2510286*1010~
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*POWELL*FRED****MI*5J34NA7XN82~
DMG*D8*19670413*M~
DTP*291*RD8*20251013-20260111~
EQ*42~
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SE*14*000034014~
GE*1*34014~
IEA*1*000034014~