| CASE NUMBER | I-200-24190-179335 |
| CASE STATUS | Certified |
| RECEIVED DATE | 7/8/2024 |
| DECISION DATE | 7/15/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Hospitalist Physician |
| SOC CODE | 29-1229.02 |
| SOC TITLE | Hospitalists |
| FULL TIME POSITION | Y |
| BEGIN DATE | 9/1/2024 |
| END DATE | 8/31/2027 |
| 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 | Southeastern Intensivist Services, P.C. |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 265 Brookview Centre Way |
| EMPLOYER ADDRESS2 | Ste. 203 |
| EMPLOYER CITY | Knoxville |
| EMPLOYER STATE | TN |
| EMPLOYER POSTAL CODE | 37919 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | +18656931000 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 621111 |
| EMPLOYER POC LAST NAME | Dabbs |
| EMPLOYER POC FIRST NAME | Randal |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Authorized Signatory |
| EMPLOYER POC ADDRESS1 | 265 Brookview Centre Way |
| EMPLOYER POC ADDRESS2 | Ste. 203 |
| EMPLOYER POC CITY | Knoxville |
| EMPLOYER POC STATE | TN |
| EMPLOYER POC POSTAL CODE | 37919 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | +18656931000 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | Tiffany_Goins@teamhealth.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Frost |
| AGENT ATTORNEY FIRST NAME | Amanda |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | 3080 N. Litchfield Road |
| AGENT ATTORNEY ADDRESS2 | |
| AGENT ATTORNEY CITY | Goodyear |
| AGENT ATTORNEY STATE | AZ |
| AGENT ATTORNEY POSTAL CODE | 85395 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | +16235365750 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | afrost@breljelaw.com |
| LAWFIRM NAME BUSINESS NAME | Brelje & Bus Immigration Law P.C. |
| STATE OF HIGHEST COURT | AZ |
| NAME OF HIGHEST STATE COURT | Arizona Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | Yes |
| SECONDARY ENTITY BUSINESS NAME | Sentara Northern Virginia Medical Center |
| WORKSITE ADDRESS1 | 2300 Optiz Blvd. |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Woodbridge |
| WORKSITE COUNTY | PRINCE WILLIAM |
| WORKSITE STATE | VA |
| WORKSITE POSTAL CODE | 22191 |
| WAGE RATE OF PAY FROM | 165.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Hour |
| PREVAILING WAGE | $51.98 |
| PW UNIT OF PAY | Hour |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | I |
| 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 | Walling |
| PREPARER FIRST NAME | Jacklyn |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | Brelje & Bus Immigration Law P.C. |
| PREPARER EMAIL | jwalling@breljelaw.com |
| BEGIN DATE CONVERTED | 2024-01-09 |
