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GS*HS*10000*10000*251211*1312*1487113239*X*005010X279A1~
ST*270*000035446*005010X279A1~
BHT*0022*13*000035446*2512345*1312~
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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*WEISS*ROBERTA****MI*4E72G80QR19~
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DTP*291*RD8*20251211-20260311~
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IEA*1*000035446~