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GS*HS*15004*15004*251010*1110*1457998957*X*005010X279A1~
ST*270*000000176*005010X279A1~
BHT*0022*13*000000176*2510283*1110~
HL*1**20*1~
NM1*PR*2*MEDICARE*****PI*06014~
HL*2*1*21*1~
NM1*1P*2*DEVOTION HOME HEALTH CARE, LLC*****XX*1457998957~
HL*3*2*22*0~
NM1*IL*1*GARCIA*PAMELA****MI*6TD6Y80XW60~
DMG*D8*19551105*F~
DTP*291*RD8*20251010-20260108~
EQ*42~
EQ*30~
SE*14*000000176~
GE*1*176~
IEA*1*000000176~