ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *260725*1607*^*00501*000002622*0*P*>~
GS*HS*15004*15004*260725*1607*1073904009*X*005010X279A1~
ST*270*000002622*005010X279A1~
BHT*0022*13*000002622*2607206*1607~
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*ISRAEL*JACOB****MI*8DX8RV9UF41~
DMG*D8*19401013*M~
DTP*291*RD8*20260725-20261023~
EQ*42~
EQ*30~
SE*14*000002622~
GE*1*2622~
IEA*1*000002622~