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GS*HS*10000*10000*260130*1401*1487113239*X*005010X279A1~
ST*270*000039494*005010X279A1~
BHT*0022*13*000039494*260130*1401~
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*WRIGHT*BERNICE****MI*1DP2EW4JR93~
DMG*D8*19511022*F~
DTP*291*RD8*20260130-20260430~
EQ*42~
EQ*30~
SE*14*000039494~
GE*1*39494~
IEA*1*000039494~