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GS*HS*52095*52095*260914*1509*1487113239*X*005010X279A1~
ST*270*000050929*005010X279A1~
BHT*0022*13*000050929*2609257*1509~
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*WATSON*RONALD****MI*55268630~
DMG*D8*19490320*M~
DTP*291*RD8*20260914-20261213~
EQ*42~
EQ*30~
SE*14*000050929~
GE*1*50929~
IEA*1*000050929~