| CASE NUMBER | I-200-25030-653455 |
| CASE STATUS | Certified |
| RECEIVED DATE | 1/30/2025 |
| DECISION DATE | 2/6/2025 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Pediatrician |
| SOC CODE | 29-1221.00 |
| SOC TITLE | Pediatricians, General |
| FULL TIME POSITION | Y |
| BEGIN DATE | 8/1/2025 |
| END DATE | 7/31/2028 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 1 |
| EMPLOYER NAME | Andalusia Physician Services, LLC |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 301 Medical Park Drive |
| EMPLOYER ADDRESS2 | Suite A |
| EMPLOYER CITY | Andalusia |
| EMPLOYER STATE | AL |
| EMPLOYER POSTAL CODE | 36420 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 13344282273 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 62111 |
| EMPLOYER POC LAST NAME | Hebenstreit |
| EMPLOYER POC FIRST NAME | Mark |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Vice President, Physician Enterprise |
| EMPLOYER POC ADDRESS1 | 301 Medical Park Drive |
| EMPLOYER POC ADDRESS2 | Suite A |
| EMPLOYER POC CITY | Andalusia |
| EMPLOYER POC STATE | AL |
| EMPLOYER POC POSTAL CODE | 36420 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 12392878179 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | Mark.Hebenstreit@scionhealth.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Duong |
| AGENT ATTORNEY FIRST NAME | Hon-Vinh |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | 511 Union Street |
| AGENT ATTORNEY ADDRESS2 | Suite 2700 |
| AGENT ATTORNEY CITY | Nashville |
| AGENT ATTORNEY STATE | TN |
| AGENT ATTORNEY POSTAL CODE | 37219 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 16158508936 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | flag@hklaw.com |
| LAWFIRM NAME BUSINESS NAME | Holland & Knight LLP |
| STATE OF HIGHEST COURT | TN |
| NAME OF HIGHEST STATE COURT | Tennessee Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 301 Medical Park Drive |
| WORKSITE ADDRESS2 | Suite A |
| WORKSITE CITY | Andalusia |
| WORKSITE COUNTY | COVINGTON |
| WORKSITE STATE | AL |
| WORKSITE POSTAL CODE | 36420 |
| WAGE RATE OF PAY FROM | $162,178.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | $170,000.00 |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $162,178.00 |
| 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 | Hamm (24218) |
| PREPARER FIRST NAME | Zoey |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | Holland & Knight LLP |
| PREPARER EMAIL | zoey.hamm@hklaw.com |
| BEGIN DATE CONVERTED | 2025-08-01 |
