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GS*HS*10000*10000*251210*1312*1487113239*X*005010X279A1~
ST*270*000034101*005010X279A1~
BHT*0022*13*000034101*2512344*1312~
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*SMITH*PEARL****MI*1JP1U28UA29~
DMG*D8*19440709*F~
DTP*291*RD8*20251210-20260310~
EQ*42~
EQ*30~
SE*14*000034101~
GE*1*34101~
IEA*1*000034101~