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GS*HS*10000*10000*260124*1301*1487113239*X*005010X279A1~
ST*270*000039343*005010X279A1~
BHT*0022*13*000039343*260124*1301~
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*SMITH*BARBARA****MI*7KG1YR4XN34~
DMG*D8*19670705*M~
DTP*291*RD8*20260124-20260424~
EQ*42~
EQ*30~
SE*14*000039343~
GE*1*39343~
IEA*1*000039343~