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GS*HS*10000*10000*260107*1201*1487113239*X*005010X279A1~
ST*270*000038636*005010X279A1~
BHT*0022*13*000038636*260107*1201~
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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*MOORE*EVETTE****MI*3RD5KA5EG56~
DMG*D8*19561002*F~
DTP*291*RD8*20260107-20260407~
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IEA*1*000038636~