Raw X12 — CIN YX47686S

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*1952*|*00501*564362924*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1952*362924*X*005010X279A1~ST*270*2924*005010X279A1~BHT*0022*13*202608121952000001*20260812*1952~HL*1**20*1~NM1*PR*2*NYSDOH*****PI*EMEDNY~HL*2*1*21*1~NM1*1P*2*MEDICAID PLANNING GROUP CORP*****SV*08046628~PRV*PE*PXC*251B00000X~HL*3*2*22*0~TRN*1*202608121952000001*00000000ND~NM1*IL*1******MI*YX47686S~EQ*30~DTP*291*D8*20260813~SE*13*2924~GE*1*362924~IEA*1*564362924~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1552*^*00501*529152430*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155238*529152430*X*005010X279A1~ST*271*529152430*005010X279A1~BHT*0022*11*202608121952000001*20260812*155238~HL*1**20*1~NM1*PR*2*NYSDOH*****FI*141797357~PER*IC*EMEDNY PROVIDER SERVICES*TE*8003439000*UR*www.emedny.org~HL*2*1*21*1~NM1*1P*2*MEDICAID PLANNING GROUP CORP*****SV*08046628~HL*3*2*22*0~TRN*2*202608121952000001*00000000ND~NM1*IL*1*BRATHWAITE*ILKA*M***MI*YX47686S~N3*1639 ST MARKS AVE             4~N4*BROOKLYN*NY*11233~DMG*D8*19840925*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*PD~MSG*CNTY CD=66 500~LS*2120~NM1*Y2*2*VILLAGE SENIOR SVC CORP PARTIAL LTC*****PI*VL~N3*112 CHARLES ST FL 2~N4*NEW YORK*NY*100142653~PER*IC*PROVIDER SERVICES*TE*8557692500~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*W*IND*CQ~LS*2120~NM1*Y2*2*ST VINCENTS SERVICES*****XX*1003015694~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*NEW YORK CITY HLTH & HOSP CORP*****XX*1114558509~LE*2120~EB*R*IND*30~REF*18*7NX5X17HK74~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*45*529152430~GE*1*529152430~IEA*1*529152430~