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GS*HS*10000*10000*251120*1211*1487113239*X*005010X279A1~
ST*270*000036162*005010X279A1~
BHT*0022*13*000036162*2511324*1211~
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NM1*PR*2*MEDICARE PPS*****PI*10000~
HL*2*1*21*1~
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NM1*IL*1*NGUYEN*HONGHA****MI*3H57AD1RD65~
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IEA*1*000036162~