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GS*HS*10000*10000*250731*1807*1487113239*X*005010X279A1~
ST*270*000029951*005010X279A1~
BHT*0022*13*000029951*2507212*1807~
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*JOHNSON*MARY****MI*5E92MJ3VH24~
DMG*D8*19380414*M~
DTP*291*RD8*20250731-20251029~
EQ*42~
EQ*30~
SE*14*000029951~
GE*1*29951~
IEA*1*000029951~