ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251219*1412*^*00501*000037641*0*P*>~
GS*HS*52095*52095*251219*1412*1487113239*X*005010X279A1~
ST*270*000037641*005010X279A1~
BHT*0022*13*000037641*2512353*1412~
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*HIBBERT*STEPHANEY****MI*81160764~
DMG*D8*19600508*F~
DTP*291*RD8*20251219-20260319~
EQ*42~
EQ*30~
SE*14*000037641~
GE*1*37641~
IEA*1*000037641~