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GS*HC*1457998957*SKAZ0*20260604*1218*1822*X*005010X222A1~
ST*837*121822*005010X222A1~
BHT*0019*00*000004*20260604*1218*CH~
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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~
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REF*EI*843850735~
PER*IC*MARIA HUTTO*TE*4804154423~
HL*2*1*22*0~
SBR*P*18**UNKNOWN*****MC~
NM1*IL*1*SAM*CATHLEEN****MI*A00190970~
N3*1919 E VILLA ST APT 10103~
N4*PHOENIX*AZ*85001~
DMG*D8*19650708*F~
NM1*PR*2*AHCCCS*****PI*SKAZ0~
N3*P O BOX 1700~
N4*PHOENIX*AZ*850029999~
CLM*1184-260604121822*117.76***12>B>1*Y*A*Y*Y~
REF*G1*1558237~
HI*ABK>I2510*ABF>E1142*ABF>M170*ABF>C50919*ABF>I10*ABF>J4520*ABF>G4733*ABF>E785*ABF>K219*ABF>E559*ABF>F17210*ABF>Z7982*ABF>Z7984~
NM1*DN*1*MILLER*TAMARA****XX*1538363254~
NM1*77*2*HOME*****XX*~
N3*11201 N TATUM BLVD, SUITE 300~
N4*PHOENIX*AZ*850286039~
LX*1~
SV1*HC>G0299*117.76*UN*94***1>2>3>4~
DTP*472*D8*20260505~
SE*34*121822~
GE*1*1822~
IEA*1*604121822~