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GS*HS*10000*10000*250818*1408*1487113239*X*005010X279A1~
ST*270*000031050*005010X279A1~
BHT*0022*13*000031050*2508230*1408~
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*EASTERLING*LETTIE****MI*4T96RC4TA48~
DMG*D8*19350222*F~
DTP*291*RD8*20250818-20251116~
EQ*42~
EQ*30~
SE*14*000031050~
GE*1*31050~
IEA*1*000031050~