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GS*HS*10000*10000*260527*1305*1487113239*X*005010X279A1~
ST*270*000046353*005010X279A1~
BHT*0022*13*000046353*2605147*1305~
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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*BRUCE****MI*3JE9D57CE45~
DMG*D8*19440324*M~
DTP*291*RD8*20260527-20260825~
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IEA*1*000046353~