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GS*HS*10000*10000*260623*1406*1487113239*X*005010X279A1~
ST*270*000047952*005010X279A1~
BHT*0022*13*000047952*2606174*1406~
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*HACKETT*RICHARD****MI*7D17JP3QY49~
DMG*D8*19570806*M~
DTP*291*RD8*20260623-20260921~
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IEA*1*000047952~