ISA*00*          *00*          *30*541855514      *ZZ*60054          *100810*0951*U*00401*000000005*1*P*:~
GS*HC*541855514*60054*20100810*0951*5*X*004010X098A1~
ST*837*000005~
BHT*0019*00*000005*20100810*0951*CH~
REF*87*004010X098A1~
NM1*41*2*ATLANTIC ANESTHESIA INC*****46*541855514~
PER*IC*NICOLE SCHAIBLE*TE*7574730044~
NM1*40*2*AETNA*****46*60054~
HL*1**20*1~
NM1*85*2*ATLANTIC ANESTHESIA INC.*****XX*1720181514~
N3*134 BUSINESS PARK DR~
N4*VIRGINIA BEACH*VA*23462~
REF*EI*541855514~
NM1*87*2*ATLANTIC ANESTHESIA INC.*****XX*1720181514~
N3*134 BUSINESS PARK DR~
N4*VIRGINIA BEACH*VA*23462~
REF*EI*541855514~
HL*2*1*22*0~
SBR*P*18*380064*AETNA*****MB~
NM1*IL*1*FRITTS*CHARLES****MI*MEBFG06Y~
N3*1052 PRINCESS ANNE RD~
N4*VIRGINIA BEACH*VA*234570000~
DMG*D8*19360703*M~
NM1*PR*2*AETNA MEDICARE PART C*****PI*60054~
HL*3*2*23*0~
PAT*01~
NM1*QC*1*JONES*HEATHER*L~
N3*2015 KINSTON WATERS CT~
N4*CHESAPEAKE*VA*233230000~
DMG*D8*19741130*F~
CLM*000477888*3033.28***21::1*Y*A*Y*Y*B~
DTP*435*D8*20100615~
DTP*096*D8*20100615~
HI*BK*57420~
NM1*DN*1*BERGER*JEFFREY*J***XX*1235178955~
NM1*FA*2*SENTARA VA BEACH GENERAL*****XX*1629038336~
N3*1060 FIRST COLONIAL ROAD~
N4*VIRGINIA BEACH*VA*234543002~
LX*1~
SV1*HC:00790:P3:QK*2210*MJ*130***1~
DTP*472*D8*20100615~
REF*6R*20100615001~
NTE*ADD*ANESTHESIA  1715 THRU       1925~
NM1*82*1*VERFURTH MD*FRANCIS*T***XX*1043235542~
PRV*PE*ZZ*207L00000X~
REF*EI*541855514~
SVD***HC:00790:P3:QK**130*1~
LX*2~
SV1*HC:00790:P3:QX*823.28*MJ*130***1~
DTP*472*D8*20100615~
REF*6R*20100615002~
NTE*ADD*ANESTHESIA  1715 THRU       1925~
NM1*82*1*HUX CRNA*STACY*L***XX*1861664518~
PRV*PE*ZZ*367500000X~
REF*EI*541855514~
SVD***HC:00790:P3:QX**130*1~
HL*4**20*1~
NM1*85*2*ATLANTIC ANESTHESIA INC.*****XX*1720181514~
N3*134 BUSINESS PARK DR~
N4*VIRGINIA BEACH*VA*23462~
REF*EI*541855514~
NM1*87*2*ATLANTIC ANESTHESIA INC.*****XX*1720181514~
N3*134 BUSINESS PARK DR~
N4*VIRGINIA BEACH*VA*23462~
REF*EI*541855514~
HL*5*4*22*~
SBR*P**081138003000198*AETNA*****ZZ~
NM1*IL*1*OLSON*BORIS*F***MI*827927489~
N3*2015 KINSTON WATERS CT~
N4*CHESAPEAKE*VA*23323~
DMG*D8*19720529~
NM1*PR*2*AETNA*****PI*60054~
CLM*000395203*1820***21::1*Y*A*Y*Y*B~
DTP*435*D8*20100726~
DTP*096*D8*20100726~
HI*BK*650~
NM1*DN*1*DATTEL*BONNIE****XX*1265405096~
NM1*FA*2*SENTARA NORFOLK GENERAL*****XX*1437119310~
N3*600 GRESHAM DRIVE~
N4*NORFOLK*VA*235071904~
LX*3~
SV1*HC:01967*1820*MJ*125***1~
DTP*472*D8*20100726~
REF*6R*20100726001~
NTE*ADD*ANESTHESIA  1830 THRU       2035~
NM1*82*1*RUIZ MD*ABELARDO*A***XX*1285652107~
PRV*PE*ZZ*207L00000X~
REF*EI*541855514~
SVD***HC:01967**125*1~
SE*88*5~
GE*1*5~
IEA*1*5~
