ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *251113*1611*^*00501*000001003*0*P*>~
GS*HS*15004*15004*251113*1611*1073904009*X*005010X279A1~
ST*270*000001003*005010X279A1~
BHT*0022*13*000001003*2511317*1611~
HL*1**20*1~
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*MATTHEWS*BEVERLY****MI*8JD4FU6QG86~
DMG*D8*19400229*F~
DTP*291*RD8*20251113-20260211~
EQ*42~
EQ*30~
SE*14*000001003~
GE*1*1003~
IEA*1*000001003~