Individual provider Active NPI

Mary Susan Gable, MD

  • Psychiatry Physician
  • El Dorado Hills, CA
National Provider Identifier
1104118637
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A105881 Issued in CA
Practice address
529 Groth CT
El Dorado Hills, CA 95762-9424
Phone
(408) 309-6370
NPI assigned
May 2, 2011
Last updated
Feb 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A105881 CA
Psychiatry Physician 2084P0800X A105881 CA Primary

Addresses

Primary practice location

529 Groth CT
El Dorado Hills, CA 95762-9424

Mailing address

21206 Sarahills Dr
Saratoga, CA 95070-4869
Phone (408) 867-0195

Other practice location 1

5170 Golden Foothill Pkwy
El Dorado Hills, CA 95762-9608
Phone (916) 314-3822

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250319002259 CA Practitioner - Psychiatry 0244656544 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A105881CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Elevate Psychiatric Care LLC Current Accepting new patients
County of Sonoma Current Accepting new patients
County of Sonoma CurrentSince Feb 17, 2025 Accepting new patients

Locations

2225 Challenger Way
Santa Rosa, CA 95407
Phone (707) 565-4101

1450 Neotomas Ave
Ste 200
Santa Rosa, CA 95405
Phone (707) 565-4131

Interoperability endpoints

  • Direct secure messaging: joshua.dyer.p1@direct.tpcp.nextgenshare.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1304294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1104118637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21206 SARAHILLS DR",
            "city": "SARATOGA",
            "state": "CA",
            "postal_code": "950704869",
            "telephone_number": "408-867-0195",
            "fax_number": "408-877-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 GROTH CT",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957629424",
            "telephone_number": "408-309-6370"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5170 Golden Foothill Pkwy",
            "address_purpose": "LOCATION",
            "city": "El Dorado Hills",
            "state": "CA",
            "postal_code": "957629608",
            "country_code": "US",
            "telephone_number": "916-314-3822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GABLE",
        "first_name": "MARY",
        "middle_name": "SUSAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-02",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A105881",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A105881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Dorado Hills, CA

Sources for this page

Verify at the official NPI Registry.