| CASE NUMBER | I-200-24001-601137 |
| CASE STATUS | Certified |
| RECEIVED DATE | 1/1/2024 |
| DECISION DATE | 1/8/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Physician |
| SOC CODE | 29-1243.00 |
| SOC TITLE | Pediatric Surgeons |
| 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 | 0 |
| NEW CONCURRENT EMPLOYMENT | 1 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | Nebraska Pediatric Practice, Inc. |
| TRADE NAME DBA | Children's Specialty Physicians |
| EMPLOYER ADDRESS1 | 8200 Dodge Street |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Omaha |
| EMPLOYER STATE | NE |
| EMPLOYER POSTAL CODE | 68114 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 14029556971 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 62111 |
| EMPLOYER POC LAST NAME | Simonsen |
| EMPLOYER POC FIRST NAME | Kari |
| EMPLOYER POC MIDDLE NAME | A |
| EMPLOYER POC JOB TITLE | Pediatrician-in-chief |
| EMPLOYER POC ADDRESS1 | 8200 Dodge Street |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Omaha |
| EMPLOYER POC STATE | NE |
| EMPLOYER POC POSTAL CODE | 68114 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 14029553933 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | s.montgomery@unmc.edu |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Rock |
| AGENT ATTORNEY FIRST NAME | Daniel |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | 9290 W Dodge Rd, Suite 303 |
| AGENT ATTORNEY ADDRESS2 | |
| AGENT ATTORNEY CITY | Omaha |
| AGENT ATTORNEY STATE | NE |
| AGENT ATTORNEY POSTAL CODE | 68114 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 14023900390 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | drock@ellickjones.com |
| LAWFIRM NAME BUSINESS NAME | Ellick Jones Law Office |
| STATE OF HIGHEST COURT | NE |
| NAME OF HIGHEST STATE COURT | NEBRASKA Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 8200 Dodge Street |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Omaha |
| WORKSITE COUNTY | DOUGLAS |
| WORKSITE STATE | NE |
| WORKSITE POSTAL CODE | 68114 |
| WAGE RATE OF PAY FROM | 228000 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $71,053.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | III |
| 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 | Rock |
| PREPARER FIRST NAME | Daniel |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | Ellick Jones Law Office |
| PREPARER EMAIL | drock@ellickjones.com |
| BEGIN DATE CONVERTED | 2024-01-07 |
