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PID||10181^^^^|||DOE^JANE^J^^MRS||19170209|F|||20863 STEVENS CREEK BLVD^SUITE 540^CUPERTINO^CA^95014||4088733030^PRN^PH~4088733036^PRN^BP~4088733037^EMR^CP|4088733033^WPN^PH~4088733034^WPN^FX~^NET^Internet^janedoe@bizmaticsinc.com||S||10181|123456789
NK1|0001|DOE^JOHN^K^^MR|SPOUSE|20863 STEVENS CREEK BLVD^SUITE 540^CUPERTINO^CA^95014|4088733030|4088733569|EC|||||||||19141012|||||||||||||||||||||222333444
PV1||O|||||^STEPHENS^KEMP|^GLEEMAN^ROBERT||||||||||||
GT1|0001|8166AAAA|DOE^JANE||20863 STEVENS CREEK BLVD^SUITE 540^CUPERTINO^CA^95014|4088733030||19170209|F||1|123456789
IN1|0001|001||MEDICARE|PO Box 2804^^CHICO^CA^95927-2804||9167431587|||||20010701||||DOE^JANE|J|19170209|20863 STEVENS CREEK BLVD ^SUITE 540^CUPERTINO^CA^95014||CO|1||||||||||||||675122377E|||||||F
IN1|0002|001||UNITED HEALTH CARE|P O BOX 30555^^SALT LAKE CITY^UT^84130-|||||||20010701||||DOE^JANE|J|19170209|20863 STEVENS CREEK BLVD^SUITE 540^CUPERTINO^CA^95014||CO|2||||||||||||||662272461|||||||F