ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *251114*1711*^*00501*000001016*0*P*>~
GS*HS*15004*15004*251114*1711*1073904009*X*005010X279A1~
ST*270*000001016*005010X279A1~
BHT*0022*13*000001016*2511318*1711~
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*STOCKTON*CARLTON****MI*7UW4G36MY94~
DMG*D8*19401019*M~
DTP*291*RD8*20251114-20260212~
EQ*42~
EQ*30~
SE*14*000001016~
GE*1*1016~
IEA*1*000001016~