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GS*HS*10000*10000*260818*1008*1487113239*X*005010X279A1~
ST*270*000050048*005010X279A1~
BHT*0022*13*000050048*2608230*1008~
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*DEVOE*MICHAEL****MI*3KU1AM8PE37~
DMG*D8*19551213*M~
DTP*291*RD8*20260818-20261116~
EQ*42~
EQ*30~
SE*14*000050048~
GE*1*50048~
IEA*1*000050048~