| LCA CASE NUMBER | I-200-21179-430269 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-06-28 |
| DECISION DATE | 2021-07-06 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Pediatric Hospitalist |
| SOC CODE | 29-1065.00 |
| SOC TITLE | Pediatricians, General |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-07-19 |
| END DATE | 2024-07-18 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 1 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Centennial Medical Group, Inc. |
| TRADE NAME DBA | Centennial Medical Group, Inc. |
| EMPLOYER ADDRESS1 | 201 Medical Loop |
| EMPLOYER ADDRESS2 | Suite 190 |
| EMPLOYER CITY | Roseburg |
| EMPLOYER STATE | OR |
| EMPLOYER POSTAL CODE | 97471 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 15416772453 |
| NAICS CODE | 621111 |
| EMPLOYER POC LAST NAME | Groshong |
| EMPLOYER POC FIRST NAME | Aric |
| EMPLOYER POC JOB TITLE | Physician Director |
| EMPLOYER POC ADDRESS1 | 201 Medical Loop |
| EMPLOYER POC ADDRESS2 | Suite 190 |
| EMPLOYER POC CITY | Roseburg |
| EMPLOYER POC STATE | OR |
| EMPLOYER POC POSTAL CODE | 97471 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 15416772888 |
| EMPLOYER POC EMAIL | AricGroshong@chiwest.com |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Bell |
| AGENT ATTORNEY FIRST NAME | Jeffrey |
| AGENT ATTORNEY MIDDLE NAME | S |
| AGENT ATTORNEY ADDRESS1 | 900 West 48th Place |
| AGENT ATTORNEY ADDRESS2 | Suite 900 |
| AGENT ATTORNEY CITY | Kansas City |
| AGENT ATTORNEY STATE | MO |
| AGENT ATTORNEY POSTAL CODE | 64112 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | MO |
| AGENT ATTORNEY PHONE | 18163604264 |
| AGENT ATTORNEY EMAIL ADDRESS | jbell@polsinelli.com |
| LAWFIRM NAME BUSINESS NAME | Polsinelli |
| STATE OF HIGHEST COURT | MO |
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 2700 NW Stewart Parkway |
| LCA CASE WORKLOC1 CITY | Roseburg |
| WORKSITE COUNTY | DOUGLAS |
| LCA CASE WORKLOC1 STATE | OR |
| WORKSITE POSTAL CODE | 97471 |
| LCA CASE WAGE RATE FROM | 200000 |
| LCA CASE WAGE RATE TO | 230000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 159411 |
| 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 |
| H-1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Bell |
| PREPARER FIRST NAME | Jeffrey |
| PREPARER MIDDLE INITIAL | S |
| PREPARER BUSINESS NAME | Polsinelli PC |
| PREPARER EMAIL | jbell@polsinelli.com |
