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GS*HS*10000*10000*260103*0101*1487113239*X*005010X279A1~
ST*270*000038112*005010X279A1~
BHT*0022*13*000038112*260103*0101~
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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*VOLAND*THERESA****MI*4MT9QD1PU28~
DMG*D8*19570710*F~
DTP*291*RD8*20260103-20260403~
EQ*42~
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IEA*1*000038112~