| LCA CASE NUMBER | I-200-21103-221057 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-04-13 |
| DECISION DATE | 2021-04-20 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Internal Medicine Physician |
| SOC CODE | 29-1063.00 |
| SOC TITLE | Internists, General |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-07-01 |
| END DATE | 2024-06-30 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 1 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Northwest Benton County Physician Services, LLC |
| EMPLOYER ADDRESS1 | 2900 Medical Center Parkway |
| EMPLOYER CITY | Bentonville |
| EMPLOYER STATE | AR |
| EMPLOYER POSTAL CODE | 72712 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 14797574002 |
| NAICS CODE | 621111 |
| EMPLOYER POC LAST NAME | Park |
| EMPLOYER POC FIRST NAME | Denten |
| EMPLOYER POC JOB TITLE | Market CEO |
| EMPLOYER POC ADDRESS 1 | 2900 Medical Center Parkway |
| EMPLOYER POC CITY | Bentonville |
| EMPLOYER POC STATE | AR |
| EMPLOYER POC POSTAL CODE | 72712 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 14797574002 |
| EMPLOYER POC EMAIL | [email protected] |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Taub |
| AGENT ATTORNEY FIRST NAME | Elissa |
| AGENT ATTORNEY ADDRESS1 | 1028 Oakhaven Rd |
| AGENT ATTORNEY CITY | Memphis |
| AGENT ATTORNEY STATE | TN |
| AGENT ATTORNEY POSTAL CODE | 38119 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 19016826455 |
| AGENT ATTORNEY EMAIL ADDRESS | [email protected] |
| LAWFIRM NAME BUSINESS NAME | Siskind Susser PC |
| STATE OF HIGHEST COURT | FL |
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 2900 Medical Center Parkway |
| LCA CASE WORKLOC1 CITY | Bentonville |
| WORKSITE COUNTY | BENTON |
| LCA CASE WORKLOC1 STATE | AR |
| WORKSITE POSTAL CODE | 72712 |
| LCA CASE WAGE RATE FROM | 207500 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 115190 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2020 - 6/30/2021 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | True |
| H1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Schaffler |
| PREPARER FIRST NAME | Macrae |
| PREPARER BUSINESS NAME | Siskind Susser PC |
| PREPARER EMAIL | [email protected] |
