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GS*HS*10000*10000*260203*1402*1487113239*X*005010X279A1~
ST*270*000039245*005010X279A1~
BHT*0022*13*000039245*260234*1402~
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*ROYAHN*EVELYN****MI*9QG6X88QN64~
DMG*D8*19260605*F~
DTP*291*RD8*20260203-20260504~
EQ*42~
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GE*1*39245~
IEA*1*000039245~