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GS*HS*15004*15004*251113*1111*1073904009*X*005010X279A1~
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BHT*0022*13*000000974*2511317*1111~
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NM1*PR*2*MEDICARE PPS*****PI*10000~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*OESTERLE*JOHN****MI*7CC9WD3NG25~
DMG*D8*19431209*M~
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IEA*1*000000974~