Individual provider Active NPI

Connor James Labella, PA-C

  • Physician Assistant
  • Vallejo, CA
National Provider Identifier
1033995774
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA217744 Issued in OR
Practice address
415 Georgia St
Vallejo, CA 94590-6004
Phone
(707) 556-8100
NPI assigned
Sep 7, 2023
Last updated
Apr 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA217744 OR Primary

Addresses

Primary practice location

415 Georgia St
Vallejo, CA 94590-6004

Mailing address

320 NE Columbia Ave Apt 306E
Boardman, OR 97818-9525
Phone (941) 586-2520

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250521002695 CA Practitioner - Physician Assistant 1557718889 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
La Clinica de la Raza IncGroup PAC ID 1557258282, 130 clinicians

Practice addresses (Care Compare)

210 Hospital Dr
Vallejo, CA 94589-2517
Phone (707) 645-7316

220 Hospital Dr
Vallejo, CA 94589-2517
Phone (707) 641-1900

415 Georgia St
Vallejo, CA 94590-6004
Phone (707) 556-8100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.82 of 100Reported as group
Quality
64.68
Promoting interoperability
100
Improvement activities
40
Cost
47.05

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA217744ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
La Clinica de la Raza, Inc. CurrentSince May 1, 2025 Accepting new patients
La Clinica de la Raza Inc CurrentSince May 1, 2025 Accepting new patients
La Clinica de la Raza, Inc. Past Accepting new patients

Locations

2021 Main St
Oakley, CA 94561
Phone (925) 776-8200

220 Hospital Dr
Vallejo, CA 94589
Phone (707) 641-1900

415 Georgia St
Vallejo, CA 94590
Phone (707) 556-8100

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1033995774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 NE COLUMBIA AVE APT 306E",
            "city": "BOARDMAN",
            "state": "OR",
            "postal_code": "978189525",
            "telephone_number": "941-586-2520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 GEORGIA ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945906004",
            "telephone_number": "707-556-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LABELLA",
        "first_name": "CONNOR",
        "middle_name": "JAMES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-07",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA217744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vallejo, CA

Sources for this page

Verify at the official NPI Registry.