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GS*HS*10000*10000*251023*1410*1487113239*X*005010X279A1~
ST*270*000034465*005010X279A1~
BHT*0022*13*000034465*2510296*1410~
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*THOMAS*NORMAN****MI*7MA1KM9CK17~
DMG*D8*19570213*M~
DTP*291*RD8*20251023-20260121~
EQ*42~
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IEA*1*000034465~