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GS*HS*15004*15004*250804*1808*1457998957*X*005010X279A1~
ST*270*000000056*005010X279A1~
BHT*0022*13*000000056*2508216*1808~
HL*1**20*1~
NM1*PR*2*MEDICARE*****PI*15004~
HL*2*1*21*1~
NM1*1P*2*DEVOTION HOME HEALTH CARE, LLC*****XX*1457998957~
HL*3*2*22*0~
NM1*IL*1*TELLER*ROSIE****MI*3Q17Y90JY79~
DMG*D8*19541204*F~
DTP*291*RD8*20250804-20251102~
EQ*42~
EQ*30~
SE*14*000000056~
GE*1*56~
IEA*1*000000056~