Raw X12 — CIN YY76208A

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1925*|*00501*649152927*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1925*152927*X*005010X279A1~ST*270*2927*005010X279A1~BHT*0022*13*202608131925000001*20260813*1925~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*202608131925000001*00000000ND~NM1*IL*1******MI*YY76208A~EQ*30~DTP*291*D8*20260814~SE*13*2927~GE*1*152927~IEA*1*649152927~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1525*^*00501*542445330*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152548*542445330*X*005010X279A1~ST*271*542445330*005010X279A1~BHT*0022*11*202608131925000001*20260813*152548~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*202608131925000001*00000000ND~NM1*IL*1*SEGARRA*SAMUEL****MI*YY76208A~N3*1404 NOBLE                    2K~N4*BRONX*NY*10472~DMG*D8*19420215*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260201~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*CNTY CD=66 5H9~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*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~EB*R*IND*30~REF*18*9M19NR4DN39~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*44*542445330~GE*1*542445330~IEA*1*542445330~