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GS*HS*15004*15004*260814*1408*1073904009*X*005010X279A1~
ST*270*000002682*005010X279A1~
BHT*0022*13*000002682*2608226*1408~
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*KHAZAI*ESFANDIAR****MI*4NM5Y42AN78~
DMG*D8*19390109*M~
DTP*291*RD8*20260814-20261112~
EQ*42~
EQ*30~
SE*14*000002682~
GE*1*2682~
IEA*1*000002682~

