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GS*HS*10000*10000*260911*1509*1487113239*X*005010X279A1~
ST*270*000050848*005010X279A1~
BHT*0022*13*000050848*2609254*1509~
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*HAILEY*GAVALIAN****MI*2A63P30EC06~
DMG*D8*19590528*M~
DTP*291*RD8*20260911-20261210~
EQ*42~
EQ*30~
SE*14*000050848~
GE*1*50848~
IEA*1*000050848~