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GS*HS*10000*10000*260102*1201*1487113239*X*005010X279A1~
ST*270*000027047*005010X279A1~
BHT*0022*13*000027047*260102*1201~
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*RAY*TERRY****MI*6EQ8CH8WE64~
DMG*D8*19600630*F~
DTP*291*RD8*20260102-20260402~
EQ*42~
EQ*30~
SE*14*000027047~
GE*1*27047~
IEA*1*000027047~