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GS*HC*52095*52095*20260914*1407*0737*X*005010X223A2~
ST*837*140737*005010X223A2~
BHT*0019*00*000004*20260914*1407*CH~
NM1*41*2*HOMECENTRIS HEALTHCARE LLC*****46*833992125~
PER*IC*MATT AUMAN*TE*4103218448~
NM1*40*2*KAISER PERMANENTE MEDICAID JOINT*****46*10403~
HL*1**20*1~
PRV*BI*PXC*251E00000X~
NM1*85*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
N3*10 CROSSROADS DRIVE, SUITE 102~
N4*OWINGS MILLS*MD*211178284~
REF*EI*833992125~
PER*IC*MATT AUMAN*TE*4103218448~
HL*2*1*22*0~
SBR*P*18*******CI~
NM1*IL*1*WELDEGIORGIS*TEJETU****MI*16254499~
N3*6539 TYDINGS RD~
N4*SYKESVILLE*MD*21784~
DMG*D8*19621214*F~
NM1*PR*2*KAISER PERMANENTE MEDICAID JOINT*****PI*10403~
N3*10 CROSSROADS DRIVE SUITE 102~
N4*OWINGS MILLS*MD*211179999~
CLM*1150-260914140737*3500***32>A>2**A*Y*Y*********~
DTP*434*RD8*20260813-20260819~
DTP*435*DT*202608130001~
CL1*9*2*30~
REF*G1*1721093766-1,1721093607-1~
HI*ABK>Z471~
HI*ABF>Z96651*ABF>M1712*ABF>K31A0*ABF>N83201*ABF>M109*ABF>Z9049*ABF>Z903~
HI*BH>50>D8>20260813~
NM1*71*1*HUANG  *JAMES****XX*1154567709~
LX*1~
SV2*0551*HC>G0299*700.00*UN*1~
DTP*472*D8*20260813~
LX*2~
SV2*0421*HC>G0151*700.00*UN*1~
DTP*472*D8*20260813~
LX*3~
SV2*0551*HC>G0299*700.00*UN*1~
DTP*472*D8*20260817~
LX*4~
SV2*0421*HC>G0151*700.00*UN*1~
DTP*472*D8*20260817~
LX*5~
SV2*0421*HC>G0151*700.00*UN*1~
DTP*472*D8*20260819~
SE*46*140737~
GE*1*0737~
IEA*1*914140737~