ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251112*1011*^*00501*000035513*0*P*>~
GS*HS*52095*52095*251112*1011*1487113239*X*005010X279A1~
ST*270*000035513*005010X279A1~
BHT*0022*13*000035513*2511316*1011~
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*SANTOR*BRENDA****MI*56179606~
DMG*D8*19421019*F~
DTP*291*RD8*20251112-20260210~
EQ*42~
EQ*30~
SE*14*000035513~
GE*1*35513~
IEA*1*000035513~