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GS*HS*10000*10000*260619*1006*1487113239*X*005010X279A1~
ST*270*000047846*005010X279A1~
BHT*0022*13*000047846*2606170*1006~
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*KEENE*VICKI****MI*8PF5JJ9DK51~
DMG*D8*19590515*F~
DTP*291*RD8*20260619-20260917~
EQ*42~
EQ*30~
SE*14*000047846~
GE*1*47846~
IEA*1*000047846~