ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *260113*1201*^*00501*000001473*0*P*>~
GS*HS*15004*15004*260113*1201*1073904009*X*005010X279A1~
ST*270*000001473*005010X279A1~
BHT*0022*13*000001473*260113*1201~
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*WEBSTER*LEDELL****MI*5YX2YQ5DV03~
DMG*D8*19550112*M~
DTP*291*RD8*20260113-20260413~
EQ*42~
EQ*30~
SE*14*000001473~
GE*1*1473~
IEA*1*000001473~