ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251007*1210*^*00501*000030822*0*P*>~
GS*HS*52095*52095*251007*1210*1487113239*X*005010X279A1~
ST*270*000030822*005010X279A1~
BHT*0022*13*000030822*2510280*1210~
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*GUIDERA*JOHN****MI*27295033~
DMG*D8*19550129*M~
DTP*291*RD8*20251007-20260105~
EQ*42~
EQ*30~
SE*14*000030822~
GE*1*30822~
IEA*1*000030822~