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GS*HS*10000*10000*260709*1107*1487113239*X*005010X279A1~
ST*270*000048859*005010X279A1~
BHT*0022*13*000048859*2607190*1107~
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*BANKS*DELORES****MI*8HW0RQ7FC07~
DMG*D8*19610327*F~
DTP*291*RD8*20260709-20261007~
EQ*42~
EQ*30~
SE*14*000048859~
GE*1*48859~
IEA*1*000048859~