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GS*HS*10000*10000*251009*1010*1487113239*X*005010X279A1~
ST*270*000026981*005010X279A1~
BHT*0022*13*000026981*2510282*1010~
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*AMIN-EL*ALIYA****MI*2XR6DT2CM51~
DMG*D8*19470225*M~
DTP*291*RD8*20251009-20260107~
EQ*42~
EQ*30~
SE*14*000026981~
GE*1*26981~
IEA*1*000026981~