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BHT*0022*13*000000127*2512345*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*SPRIGGS JOHNSON*CATHERINE****MI*3WC9RD7AK28~
DMG*D8*19500824*F~
DTP*291*RD8*20251211-20260311~
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IEA*1*000000127~