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GS*HS*52095*52095*260513*1505*1487113239*X*005010X279A1~
ST*270*000045876*005010X279A1~
BHT*0022*13*000045876*2605133*1505~
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*PETERSON*DAVID****MI*64321657~
DMG*D8*19800125*M~
DTP*291*RD8*20260513-20260811~
EQ*42~
EQ*30~
SE*14*000045876~
GE*1*45876~
IEA*1*000045876~