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GS*HS*15004*15004*250821*1808*1457998957*X*005010X279A1~
ST*270*000000096*005010X279A1~
BHT*0022*13*000000096*2508233*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*PERKINS*LAVONNE****MI*1NN4V13UT73~
DMG*D8*19311208*F~
DTP*291*RD8*20250821-20251119~
EQ*42~
EQ*30~
SE*14*000000096~
GE*1*96~
IEA*1*000000096~