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GS*HS*10000*10000*260610*1306*1487113239*X*005010X279A1~
ST*270*000047651*005010X279A1~
BHT*0022*13*000047651*2606161*1306~
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*RICARDO*JOSE****MI*8V66UJ1RV81~
DMG*D8*19560318*M~
DTP*291*RD8*20260610-20260908~
EQ*42~
EQ*30~
SE*14*000047651~
GE*1*47651~
IEA*1*000047651~