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GS*HS*52095*52095*251030*1110*1487113239*X*005010X279A1~
ST*270*000034736*005010X279A1~
BHT*0022*13*000034736*2510303*1110~
HL*1**20*1~
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*REYNOLDS*MATTHEW****MI*100005662~
DMG*D8*19840710*M~
DTP*291*RD8*20251030-20260128~
EQ*42~
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SE*14*000034736~
GE*1*34736~
IEA*1*000034736~