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GS*HS*15004*15004*260626*1406*1457998957*X*005010X279A1~
ST*270*000047479*005010X279A1~
BHT*0022*13*000047479*2606177*1406~
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*BUTLER*CHARMELLE****MI*4A78VJ2TD67~
DMG*D8*19740114*F~
DTP*291*RD8*20260626-20260924~
EQ*42~
EQ*30~
SE*14*000047479~
GE*1*47479~
IEA*1*000047479~