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GS*HS*52095*52095*260708*1407*1487113239*X*005010X279A1~
ST*270*000046139*005010X279A1~
BHT*0022*13*000046139*2607189*1407~
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*THOMPSON*RODERICK****MI*271284818~
DMG*D8*19590503*M~
DTP*291*RD8*20260708-20261006~
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IEA*1*000046139~