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GS*HS*52095*52095*260909*0709*1487113239*X*005010X279A1~
ST*270*000050466*005010X279A1~
BHT*0022*13*000050466*2609252*0709~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE COMMERCIAL JOINT*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*SIMMONS*TONI****MI*999349022~
DMG*D8*19470907*M~
DTP*291*RD8*20260909-20261208~
EQ*42~
EQ*30~
SE*14*000050466~
GE*1*50466~
IEA*1*000050466~