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GS*HS*10000*10000*260603*1606*1487113239*X*005010X279A1~
ST*270*000046557*005010X279A1~
BHT*0022*13*000046557*2606154*1606~
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*GREEN*BONNY****MI*5A25AC8FH87~
DMG*D8*19841207*F~
DTP*291*RD8*20260603-20260901~
EQ*42~
EQ*30~
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GE*1*46557~
IEA*1*000046557~