Raw X12 — CIN YS92632H

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*1954*|*00501*564488057*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1954*488057*X*005010X279A1~ST*270*8057*005010X279A1~BHT*0022*13*202608121954000001*20260812*1954~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*202608121954000001*00000000ND~NM1*IL*1******MI*YS92632H~EQ*30~DTP*291*D8*20260813~SE*13*8057~GE*1*488057~IEA*1*564488057~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1554*^*00501*529614530*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155443*529614530*X*005010X279A1~ST*271*529614530*005010X279A1~BHT*0022*11*202608121954000001*20260812*155443~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*202608121954000001*00000000ND~NM1*IL*1*DAVILAJR*JOSE*L***MI*YS92632H~N3*1415 ROWLAND ST               2R~N4*BRONX*NY*10461~DMG*D8*19681126*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*ELDERPLAN INC HOMEFIRST PARTIAL LTC*****PI*ED~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8777711119~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*ESSEN MEDICAL ASSOCIATES PC*****XX*1366418709~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*SRH CHN LEAD HEALTH HOME LLC*****XX*1750053948~LE*2120~SE*40*529614530~GE*1*529614530~IEA*1*529614530~