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GS*HS*10000*10000*251209*1612*1487113239*X*005010X279A1~
ST*270*000037219*005010X279A1~
BHT*0022*13*000037219*2512343*1612~
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NM1*PR*2*MEDICARE PPS*****PI*10000~
HL*2*1*21*1~
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NM1*IL*1*MASON*LINDA****MI*4FH3WQ0QW01~
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DTP*291*RD8*20251209-20260309~
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IEA*1*000037219~