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GS*HS*10000*10000*260619*1106*1487113239*X*005010X279A1~
ST*270*000047856*005010X279A1~
BHT*0022*13*000047856*2606170*1106~
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*FREELAND*RAMONA****MI*4H55JQ5MT40~
DMG*D8*19570910*F~
DTP*291*RD8*20260619-20260917~
EQ*42~
EQ*30~
SE*14*000047856~
GE*1*47856~
IEA*1*000047856~