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GS*HS*10000*10000*260406*1904*1487113239*X*005010X279A1~
ST*270*000041670*005010X279A1~
BHT*0022*13*000041670*260496*1904~
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*JONES*MAGALINE****MI*1YF3R37CH00~
DMG*D8*19400308*F~
DTP*291*RD8*20260406-20260705~
EQ*42~
EQ*30~
SE*14*000041670~
GE*1*41670~
IEA*1*000041670~