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GS*HS*10000*10000*251223*1612*1487113239*X*005010X279A1~
ST*270*000037775*005010X279A1~
BHT*0022*13*000037775*2512357*1612~
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*MARCINIAK*THERESA****MI*5CP5KT8ME53~
DMG*D8*19451015*F~
DTP*291*RD8*20251223-20260323~
EQ*42~
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SE*14*000037775~
GE*1*37775~
IEA*1*000037775~