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GS*HS*15004*15004*260427*1504*1073904009*X*005010X279A1~
ST*270*000002178*005010X279A1~
BHT*0022*13*000002178*2604117*1504~
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*LEMPICKI*BEVERLY****MI*8CK7GK4KV63~
DMG*D8*19440226*F~
DTP*291*RD8*20260427-20260726~
EQ*42~
EQ*30~
SE*14*000002178~
GE*1*2178~
IEA*1*000002178~