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GS*HS*10000*10000*260804*1308*1487113239*X*005010X279A1~
ST*270*000049617*005010X279A1~
BHT*0022*13*000049617*2608216*1308~
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*SCHWARTZ*MICHAEL****MI*1MJ1FX1NC97~
DMG*D8*19461106*M~
DTP*291*RD8*20260804-20261102~
EQ*42~
EQ*30~
SE*14*000049617~
GE*1*49617~
IEA*1*000049617~