| CASE NUMBER | I-200-24285-401860 |
| CASE STATUS | Certified |
| RECEIVED DATE | 10/11/2024 |
| DECISION DATE | 10/21/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Chief, Hospital Medicine |
| SOC CODE | 29-1216.00 |
| SOC TITLE | General Internal Medicine Physicians |
| FULL TIME POSITION | Y |
| BEGIN DATE | 1/9/2025 |
| END DATE | 1/8/2028 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 1 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | Baystate Medical Practices, Inc. |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 759 Chestnut Street |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Springfield |
| EMPLOYER STATE | MA |
| EMPLOYER POSTAL CODE | 1199 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 14137942571 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 62111 |
| EMPLOYER POC LAST NAME | Hartman |
| EMPLOYER POC FIRST NAME | Carolynn |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Provider Recruitment Coordinator |
| EMPLOYER POC ADDRESS1 | Office of Physician & Adv. Practitioner Recruitment |
| EMPLOYER POC ADDRESS2 | 280 Chestnut Street |
| EMPLOYER POC CITY | Springfield |
| EMPLOYER POC STATE | MA |
| EMPLOYER POC POSTAL CODE | 1199 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 14137942325 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | carolynn.hartman@baystatehealth.org |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Peryeva |
| AGENT ATTORNEY FIRST NAME | Aleksandra |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | 79 Masonic Street |
| AGENT ATTORNEY ADDRESS2 | |
| AGENT ATTORNEY CITY | Northampton |
| AGENT ATTORNEY STATE | MA |
| AGENT ATTORNEY POSTAL CODE | 1060 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 14134617932 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | ap@peryevaimmigration.com |
| LAWFIRM NAME BUSINESS NAME | Peryeva Immigration Law Firm |
| STATE OF HIGHEST COURT | MA |
| NAME OF HIGHEST STATE COURT | Supreme Judicial Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | Baystate Wing Hospital |
| WORKSITE ADDRESS2 | 40 Wright Street |
| WORKSITE CITY | Palmer |
| WORKSITE COUNTY | PALMER |
| WORKSITE STATE | MA |
| WORKSITE POSTAL CODE | 1069 |
| WAGE RATE OF PAY FROM | $288,200.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | $390,000.00 |
| 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 | 7/1/2024 - 6/30/2025 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 4 |
| 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 | 2025-01-09 |
