| CASE NUMBER | I-200-24192-187631 |
| CASE STATUS | Certified |
| RECEIVED DATE | 7/10/2024 |
| DECISION DATE | 7/17/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Internal Medicine Physician |
| SOC CODE | 29-1216.00 |
| SOC TITLE | General Internal Medicine Physicians |
| FULL TIME POSITION | Y |
| BEGIN DATE | 10/1/2024 |
| END DATE | 9/30/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 1 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | South Broward Hospital District |
| TRADE NAME DBA | Memorial Healthcare System |
| EMPLOYER ADDRESS1 | 3111 Stirling Road |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Hollywood |
| EMPLOYER STATE | FL |
| EMPLOYER POSTAL CODE | 33312 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | +19549855972 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Primiano |
| EMPLOYER POC FIRST NAME | Angela |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Vice President, Human Resources |
| EMPLOYER POC ADDRESS1 | 3111 Stirling Road |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Hollywood |
| EMPLOYER POC STATE | FL |
| EMPLOYER POC POSTAL CODE | 33312 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | +19542657778 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | APrimiano@mhs.net |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Ombok |
| AGENT ATTORNEY FIRST NAME | Otieno |
| AGENT ATTORNEY MIDDLE NAME | B. |
| AGENT ATTORNEY ADDRESS1 | 44 South Broadway |
| AGENT ATTORNEY ADDRESS2 | 14th Floor |
| AGENT ATTORNEY CITY | White Plains |
| AGENT ATTORNEY STATE | NY |
| AGENT ATTORNEY POSTAL CODE | 10601 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | +19148726895 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | otieno.ombok@jacksonlewis.com |
| LAWFIRM NAME BUSINESS NAME | Jackson Lewis P.C |
| STATE OF HIGHEST COURT | NY |
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | Memorial Primary Care Pembroke Road |
| WORKSITE ADDRESS2 | 4105 Pembroke Road |
| WORKSITE CITY | Hollywood |
| WORKSITE COUNTY | BROWARD |
| WORKSITE STATE | FL |
| WORKSITE POSTAL CODE | 33021 |
| WAGE RATE OF PAY FROM | 225,000.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $205,462.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | Yes |
| H 1B DEPENDENT | No |
| WILLFUL VIOLATOR | No |
| SUPPORT H1B | N/A |
| STATUTORY BASIS | |
| APPENDIX A ATTACHED | N/A |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Sanchez |
| PREPARER FIRST NAME | Jennifer |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | Jackson Lewis P.C |
| PREPARER EMAIL | jennifer.sanchez@jacksonlewis.com |
| BEGIN DATE CONVERTED | 2024-01-10 |
