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DR. THEODORE WILLIS LAETSCH JR. MD
NPI 1154477834
Pediatrics in Philadelphia, PA

Active since January 26, 2007PECOS Enrolled
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104(267) 425-0126 Get Directions Write a Review

NPPES record last updated: February 19, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Theodore Willis Laetsch Jr. Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. THEODORE WILLIS LAETSCH JR. MD (NPI 1154477834) is an individual pediatrics provider in Philadelphia, Pennsylvania, licensed in Pennsylvania (MD436327) and active in the NPI registry since January 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1154477834
Entity TypeIndividualMale
Primary Taxonomy208000000X
Provider Legal NameDR. THEODORE WILLIS LAETSCH JR.Credential: MD
Location Address3401 CIVIC CENTER BLVDPhiladelphia, PA 19104-4319
Mailing Address3401 Civic Center Blvd Ste M975Philadelphia, PA 19104-4319
Phone(267) 425-0126
Sole ProprietorNo
Enumeration DateJanuary 26, 2007
Last NPPES UpdateFebruary 19, 2024
NPPES CertifiedFebruary 19, 2024
✔ NPI 1154477834 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in PA · MD436327
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Also ListedPediatrics · Pediatric Hematology-OncologyTaxonomy 2080P0207X · License P6853 (TX), MD436327 (PA)
3401 CIVIC CENTER BLVD, Philadelphia, PA 19104
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Other Identifiers 1

Medicaid13339796CO

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Theodore Willis Laetsch Jr. Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Theodore Laetsch reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Childrens Health Care Associates, Inc
Same address
Neurology
3401 CIVIC CENTER BLVD, CHILDREN'S HOSPITAL OF PHILADELPHIA
Philadelphia, PA 19104
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 1,225 clinicians in this Medicare group
NPI 1033204086 (215) 590-1000
The University Of Texas Southwestern Medical Center At Dallas
1,237 mi
Physical Medicine & Rehabilitation
1000 S BECKHAM AVE
Tyler, TX 75701
  • Reassigned Medicare billing, Texas enrollment
  • 5,299 clinicians in this Medicare group
NPI 1417099599 (214) 645-0624

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19104 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$92.69 typical visit price
range $59.88 – $180.99
Typical copayment $23.17 (range $14.97 – $45.24)
Most-billed visit code 99203
Established Patient
$105.21 typical visit price
range $19.30 – $147.29
Typical copayment $26.30 (range $4.82 – $36.82)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AARON DORFMAN M.D.
Pediatrics (Pediatric Cardiology)
3401 CIVIC CENTER BLVD, CHILDREN'S HOSPITAL OF PHILADELPHIA - CARDIOLOGY
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-4040
MS. NICOLE MARIE KOEPKE CRNP
Nurse Practitioner (Pediatrics)
3401 CIVIC CENTER BLVD, CHILDREN'S HOSPITAL OF PHILADELPHIA - EMERGENCY MED
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-1944
DR. CASSANDRA ALYS LIGH MD
Surgery (Plastic and Reconstructive Surgery)
3401 CIVIC CENTER BLVD
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-2208
DR. PREETI SOI
Psychiatry & Neurology (Child & Adolescent Psychiatry)
3401 CIVIC CENTER BLVD
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-7555
ROSALIND USHER M.D.
Pediatrics (Developmental - Behavioral Pediatrics)
3401 CIVIC CENTER BLVD, DIVISION OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-6336
DR. MATTHEW DAVID SCHREIER MD
Pediatrics (Pediatric Cardiology)
3401 CIVIC CENTER BLVD
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-1000
DR. TERRENCE CALDWELL JR. PHARMD
Pharmacist (Pediatrics)
3401 CIVIC CENTER BLVD
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-1000
ALYSSA STIEFEL CRNP
Nurse Practitioner (Pediatrics)
3401 CIVIC CENTER BLVD
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-1000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Theodore Laetsch's NPI number?

The NPI number for Theodore Laetsch is 1154477834. It was assigned to this individual provider in the NPPES registry on January 26, 2007.

Where is Theodore Laetsch located?

Theodore Laetsch practices at 3401 Civic Center Blvd, Philadelphia, PA 19104. The listed phone number is (267) 425-0126.

What is Theodore Laetsch's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Theodore Laetsch enrolled in Medicare?

Yes. Theodore Laetsch is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Theodore Laetsch's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Theodore Laetsch reassigns Medicare benefits to 2 organizations: Childrens Health Care Associates, Inc (Philadelphia, PA) and The University Of Texas Southwestern Medical Center At Dallas (Tyler, TX). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Theodore Laetsch's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Theodore Laetsch was last updated on February 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.