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GS*HS*10000*10000*251107*1311*1487113239*X*005010X279A1~
ST*270*000033979*005010X279A1~
BHT*0022*13*000033979*2511311*1311~
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*HAYES*WILLIAM****MI*9JF3R20XY72~
DMG*D8*19421209*M~
DTP*291*RD8*20251107-20260205~
EQ*42~
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SE*14*000033979~
GE*1*33979~
IEA*1*000033979~