ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251007*1810*^*00501*000032413*0*P*>~
GS*HS*52095*52095*251007*1810*1487113239*X*005010X279A1~
ST*270*000032413*005010X279A1~
BHT*0022*13*000032413*2510280*1810~
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*FUGATE*GEORGE****MI*961133423~
DMG*D8*19501110*M~
DTP*291*RD8*20251007-20260105~
EQ*42~
EQ*30~
SE*14*000032413~
GE*1*32413~
IEA*1*000032413~