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GS*HS*10000*10000*260706*1907*1487113239*X*005010X279A1~
ST*270*000048271*005010X279A1~
BHT*0022*13*000048271*2607187*1907~
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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*SHEELY*GLORIA****MI*7D78P48GV32~
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IEA*1*000048271~