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GS*HC*1457998957*SKAZ0*20260325*1545*4532*X*005010X222A1~
ST*837*154532*005010X222A1~
BHT*0019*00*000004*20260325*1545*CH~
NM1*41*2*DEVOTION HOME HEALTH CARE, LLC*****46*843850735~
PER*IC*MARIA HUTTO*TE*4804154423~
NM1*40*2*AHCCCS*****46*SKAZ0~
HL*1**20*1~
NM1*85*2*DEVOTION HOME HEALTH CARE, LLC*****XX*1457998957~
N3*11201 N TATUM BLVD, SUITE 300~
N4*PHOENIX*AZ*850286039~
REF*EI*843850735~
PER*IC*MARIA HUTTO*TE*4804154423~
HL*2*1*22*0~
SBR*P*18**UNKNOWN*****MC~
NM1*IL*1*FREDERICKS*ELLIS****MI*A21030116~
N3*2213 W POINTSETTIA DR~
N4*PHOENIX*AZ*85029~
DMG*D8*19610917*M~
NM1*PR*2*AHCCCS*****PI*SKAZ0~
N3*P O BOX 1700~
N4*PHOENIX*AZ*850029999~
CLM*1184-260325154532*121***12>B>1*Y*A*Y*Y~
REF*G1*~
HI*ABK>L03114*ABF>B9562*ABF>G40909*ABF>I10*ABF>E785*ABF>J45909*ABF>E876*ABF>E46*ABF>D649*ABF>F1510*ABF>F1010*ABF>Z87820*ABF>Z8673~
NM1*DN*1*HASSINGER*ROGER****XX*1326139924~
NM1*77*2*HOME*****XX*~
N3*11201 N TATUM BLVD, SUITE 300~
N4*PHOENIX*AZ*850286039~
LX*1~
SV1*HC>G0299*121.00*UN*0***1>2>3>4~
DTP*472*D8*20260107~
SE*34*154532~
GE*1*4532~
IEA*1*325154532~