| CASE NUMBER | I-200-24032-686241 |
| CASE STATUS | Certified |
| RECEIVED DATE | 2/1/2024 |
| DECISION DATE | 2/8/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Physician (Anesthesiology) |
| SOC CODE | 29-1211.00 |
| SOC TITLE | Anesthesiologists |
| FULL TIME POSITION | Y |
| BEGIN DATE | 7/1/2024 |
| END DATE | 6/30/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 1 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | NorthStar Anesthesia of Michigan III, PLLC |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 6225 N State Highway 161 |
| EMPLOYER ADDRESS2 | Suite 200 |
| EMPLOYER CITY | Irving |
| EMPLOYER STATE | TX |
| EMPLOYER POSTAL CODE | 75038 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 12146879301 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 62111 |
| EMPLOYER POC LAST NAME | Nguyen |
| EMPLOYER POC FIRST NAME | Jenny |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Corporate Human Resources Partner |
| EMPLOYER POC ADDRESS1 | 6225 N State Hwy 161 |
| EMPLOYER POC ADDRESS2 | Suite 200 |
| EMPLOYER POC CITY | Irving |
| EMPLOYER POC STATE | TX |
| EMPLOYER POC POSTAL CODE | 75038 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 12146879301 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | jenny.nguyen@northstaranesthesia.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Fillenwarth |
| AGENT ATTORNEY FIRST NAME | Charlotte |
| AGENT ATTORNEY MIDDLE NAME | Marie |
| AGENT ATTORNEY ADDRESS1 | 500 North Meridian Street |
| AGENT ATTORNEY ADDRESS2 | Suite 400 |
| AGENT ATTORNEY CITY | Indianapolis |
| AGENT ATTORNEY STATE | IN |
| AGENT ATTORNEY POSTAL CODE | 46204 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 13179771476 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | CFillenwarth@hallrender.com |
| LAWFIRM NAME BUSINESS NAME | Hall, Render, Killian, Heath & Lyman, P.C. |
| STATE OF HIGHEST COURT | IN |
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | Yes |
| SECONDARY ENTITY BUSINESS NAME | Beaumont Hospital, Royal Oak |
| WORKSITE ADDRESS1 | 3601 W. 13 Mile Road |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Royal Oak |
| WORKSITE COUNTY | OAKLAND |
| WORKSITE STATE | MI |
| WORKSITE POSTAL CODE | 48073 |
| WAGE RATE OF PAY FROM | 500000 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $239,200.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | N/A |
| PW OES YEAR | 7/1/2023 - 6/30/2024 |
| 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 | |
| PREPARER FIRST NAME | |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | |
| PREPARER EMAIL | |
| BEGIN DATE CONVERTED | 2024-01-07 |
