ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *251208*1712*^*00501*000001112*0*P*>~
GS*HS*15004*15004*251208*1712*1073904009*X*005010X279A1~
ST*270*000001112*005010X279A1~
BHT*0022*13*000001112*2512342*1712~
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*RIOS*MARIO****MI*2NT7PX2YG78~
DMG*D8*19530225*M~
DTP*291*RD8*20251208-20260308~
EQ*42~
EQ*30~
SE*14*000001112~
GE*1*1112~
IEA*1*000001112~