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GS*HS*52095*52095*251028*1810*1487113239*X*005010X279A1~
ST*270*000034669*005010X279A1~
BHT*0022*13*000034669*2510301*1810~
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NM1*PR*2*KAISER PERMANENTE*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*FERREIRA*MANUEL****MI*92153343~
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IEA*1*000034669~