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GS*HS*10000*10000*260912*1309*1487113239*X*005010X279A1~
ST*270*000050860*005010X279A1~
BHT*0022*13*000050860*2609255*1309~
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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*THOMAS*EDWARD****MI*1F13Q24RE12~
DMG*D8*19530202*M~
DTP*291*RD8*20260912-20261211~
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IEA*1*000050860~