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GS*HS*15004*15004*250917*1609*1487113239*X*005010X279A1~
ST*270*000032566*005010X279A1~
BHT*0022*13*000032566*2509260*1609~
HL*1**20*1~
NM1*PR*2*MEDICARE*****PI*10000~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*BANKS*SYLVIA****MI*3JT6K98AA53~
DMG*D8*19300201*F~
DTP*291*RD8*20250917-20251216~
EQ*42~
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SE*14*000032566~
GE*1*32566~
IEA*1*000032566~