ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *251123*1711*^*00501*000001050*0*P*>~
GS*HS*15004*15004*251123*1711*1073904009*X*005010X279A1~
ST*270*000001050*005010X279A1~
BHT*0022*13*000001050*2511327*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*DUNMYER*ROBERT****MI*2K76VP7PC66~
DMG*D8*19680818*M~
DTP*291*RD8*20251123-20260221~
EQ*42~
EQ*30~
SE*14*000001050~
GE*1*1050~
IEA*1*000001050~

