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GS*HS*10000*10000*251125*1311*1487113239*X*005010X279A1~
ST*270*000036327*005010X279A1~
BHT*0022*13*000036327*2511329*1311~
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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*DOTSON*IVAN****MI*2D61VQ8FW11~
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IEA*1*000036327~