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GS*HS*10000*10000*251106*1311*1487113239*X*005010X279A1~
ST*270*000035152*005010X279A1~
BHT*0022*13*000035152*2511310*1311~
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*MYERS*SHIRLEY****MI*3X82X09YD89~
DMG*D8*19500914*F~
DTP*291*RD8*20251106-20260204~
EQ*42~
EQ*30~
SE*14*000035152~
GE*1*35152~
IEA*1*000035152~