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GS*HS*10000*10000*260112*1501*1487113239*X*005010X279A1~
ST*270*000035977*005010X279A1~
BHT*0022*13*000035977*260112*1501~
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*GREEN*MARY****MI*5QE3E54HU07~
DMG*D8*19560416*F~
DTP*291*RD8*20260112-20260412~
EQ*42~
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IEA*1*000035977~