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GS*HS*10000*10000*260113*1601*1487113239*X*005010X279A1~
ST*270*000038923*005010X279A1~
BHT*0022*13*000038923*260113*1601~
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*SCHMIDT*ROSEMARY****MI*5QG2AR1AK82~
DMG*D8*19540729*M~
DTP*291*RD8*20260113-20260413~
EQ*42~
EQ*30~
SE*14*000038923~
GE*1*38923~
IEA*1*000038923~