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GS*HS*10000*10000*260728*1507*1487113239*X*005010X279A1~
ST*270*000049427*005010X279A1~
BHT*0022*13*000049427*2607209*1507~
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*SHORTS*SYLVESTER****MI*8FW3GC8GK74~
DMG*D8*19640717*M~
DTP*291*RD8*20260728-20261026~
EQ*42~
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SE*14*000049427~
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IEA*1*000049427~