ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *250909*1609*^*00501*000031770*0*P*>~
GS*HS*52095*52095*250909*1609*1487113239*X*005010X279A1~
ST*270*000031770*005010X279A1~
BHT*0022*13*000031770*2509252*1609~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE MEDICARE ADVANTAGE 1*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*SMITH*DARLENE****MI*93300439~
DMG*D8*19590224*F~
DTP*291*RD8*20250909-20251208~
EQ*42~
EQ*30~
SE*14*000031770~
GE*1*31770~
IEA*1*000031770~