THEODORE J SOUTHGATE (MD) – Cardiovascular Disease Physician, NPI 1730156217
Cardiovascular Disease Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
984 GENERAL SURGERY in NJ
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Provider Addresses for THEODORE J SOUTHGATE (MD)
Newark Beth Israel Medical Center, 201, Lyons Avenue, Newark, Essex County, New Jersey, 07112, United States
SUITE G5
NEWARK, NJ 071122027
Phone: (973) 926-7749
Fax: (973) 923-4683
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-04-18
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050418001107 | I | General Surgery | NJ | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 07112)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MA | |
| Nurse Practitioner | NJ | |
| Nurse Practitioner | NJ | |
| Critical Care (Intensivists), Pulmonary Disease | NJ | |
| - | NJ | |
| General Surgery | NJ | |
| O B S T E T R I C S/ G Y N E C O L O G Y | NJ | |
| O B S T E T R I C S/ G Y N E C O L O G Y | NJ | |
| General Surgery | NY | |
| General Surgery | NJ |
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