ISA*00*          *00*          *ZZ*00             *ZZ*               *260804*1356*U*00501*804135622*0*P*>~
GS*HC*123*123*20260804*1356*804135622*X*005010X223A2~
ST*837*135622*005010X223A2~
BHT*0019*00*000004*20260804*1308*CH~
NM1*41*2*BISTOY HOME HEALTHCARE INC.*****46*~
PER*IC*OLA FAJINMI*TE*2159173942~
NM1*40*2*Medicare*****46*123~
HL*1**20*1~
PRV*BI*PXC*251E00000X~
NM1*85*2*BISTOY HOME HEALTHCARE INC.*****XX*1871253237~
N3*501 S 4TH STREET ~
N4*DARBY*PA*190233119~
REF*EI*~
PER*IC*OLA FAJINMI*TE*2159173942~
HL*2*1*22*0~
SBR*P*18*******MA~
NM1*IL*1*HAMM*ANDRE****MI*2UC4UC3AH86~
N3*405 SHARON AVENUE~
N4*SHARON HILL*PA*19079~
DMG*D8*19851006*M~
NM1*PR*2*MEDICARE*****PI*12345~
CLM*1196-260804135622*0***32>A>A**A*Y*Y*********~
DTP*434*RD8*20260731-20260731~
DTP*435*DT*202607310000~
CL1*9*4*30~
HI*ABK>I10~
NM1*71*1*SATTAR*YUSUF****XX*1558984625~
LX*1~
SV2*0023*HP>1AA11*0.00*UN*1.00~
DTP*472*D8*20260731~
SE*33*135622~
GE*1*804135622~
IEA*1*804135622~