ISA*00*          *00*          *ZZ*00             *ZZ*               *260914*1334*U*00501*914133403*0*P*>~
GS*HC*1457998957*3432*20260914*1334*3403*X*005010X222A1~
ST*837*133403*005010X222A1~
BHT*0019*00*000004*20260914*1334*CH~
NM1*41*2*DEVOTION HOME HEALTH CARE, LLC*****46*843850735~
PER*IC*MARIA HUTTO*TE*4804154423~
NM1*40*2*UHC AHCCCS/ALTCS*****46*03432~
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*******MC~
NM1*IL*1*ZACEK*JONATHAN****MI*A42300224~
N3*4006 W HATCHER RD~
N4*PHOENIX*AZ*85051~
DMG*D8*19730528*M~
NM1*PR*2*UHC AHCCCS/ALTCS*****PI*03432~
N3*PO BOX 5290~
N4*KINGSTON*NY*124029999~
CLM*1184-260914133403*135***12>B>1*Y*A*Y*Y~
REF*G1*A328390239~
HI*ABK>E11621*ABF>L97523*ABF>L97314*ABF>E11610*ABF>T8469XA*ABF>E1142*ABF>M5416*ABF>F17210*ABF>I890*ABF>E663*ABF>Z6836*ABF>Z792~
NM1*DN*1*MALING*SCOTT****XX*1780643395~
NM1*77*2*HOME*****XX*~
N3*11201 N TATUM BLVD, SUITE 300~
N4*PHOENIX*AZ*850286039~
LX*1~
SV1*HC>S9123*135.00*UN*1***1>2>3>4~
DTP*472*D8*20260828~
SE*34*133403~
GE*1*3403~
IEA*1*914133403~