Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kyle Rotherham, PA-C

Individual provider Surgical Physician Assistant · NPI 1780397018

Kyle Rotherham, PA-C is a Physician Assistant in Omaha, Nebraska. Graduated from Creighton University School of Medicine in 2022, 4 years ago. Practices with MD West One PC, a 85-clinician group and accepts Medicare assignment. Licensed in Iowa and Nebraska.

Years since qualifying
4
Trained at
Creighton University School of Medicine
Licensed in
IA, NE
In the registry since
2023
Specialties on file
4
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

8005 Farnam Dr Ste 305
Omaha, NE 68114-3426
Phone: (402) 390-4111
Fax: (402) 390-4115
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 2867 (NE)
Physician Assistant Taxonomy 363A00000X · Licence 1204103 (NE)
Physician Assistant Taxonomy 363A00000X · Licence 2867 (NE)
Physician Assistant Taxonomy 363A00000X · Licence 118173 (IA)

Record details

NPI number1780397018
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJanuary 2, 2023
Last updated in NPPESOctober 30, 2025
Certification dateOctober 30, 2025
Mailing address8005 Farnam Dr Ste 305, Omaha, NE 68114-3426

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolCREIGHTON UNIVERSITY SCHOOL OF MEDICINE
Graduated 2022 (4 years in practice)
Group practice Md West One Pc — 85 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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