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GS*HS*10000*10000*251115*1411*1487113239*X*005010X279A1~
ST*270*000035972*005010X279A1~
BHT*0022*13*000035972*2511319*1411~
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*BEHN*BARBARA****MI*5PN2XP7TU84~
DMG*D8*19600301*F~
DTP*291*RD8*20251115-20260213~
EQ*42~
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SE*14*000035972~
GE*1*35972~
IEA*1*000035972~