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GS*HS*52095*52095*251205*1212*1487113239*X*005010X279A1~
ST*270*000036184*005010X279A1~
BHT*0022*13*000036184*2512339*1212~
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*BARNETT*GEORGE****MI*19293545~
DMG*D8*19460419*M~
DTP*291*RD8*20251205-20260305~
EQ*42~
EQ*30~
SE*14*000036184~
GE*1*36184~
IEA*1*000036184~