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GS*HS*15004*15004*251201*1312*1487113239*X*005010X279A1~
ST*270*000036488*005010X279A1~
BHT*0022*13*000036488*2512335*1312~
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*DAVIS*JAMES****MI*4YW2FJ1MU91~
DMG*D8*19450520*M~
DTP*291*RD8*20251201-20260301~
EQ*42~
EQ*30~
SE*14*000036488~
GE*1*36488~
IEA*1*000036488~