NPIMap

Organization Active NPI

McKenzie Memorial Hospital

Doing business as McKenzie Family Healthcare

  • Rural Health Clinic/Center
  • Sandusky, MI
National Provider Identifier
1083472138
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MCKENZIE MEMORIAL HOSPITAL
Doing business as
McKenzie Family Healthcare
Practice address
109 N Delaware St
Sandusky, MI 48471-1008
Phone
(810) 648-9677
Fax
(810) 648-0053
NPI assigned
Mar 12, 2024
Last updated
Oct 21, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MCKENZIE MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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

Authorized official

Name
Amy Ruedisueli
Title
Cfo
Phone
(810) 648-6162

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

109 N Delaware St
Sandusky, MI 48471-1008

Mailing address

120 N Delaware St
Sandusky, MI 48471-1009
Phone (810) 648-6199

Other names 1

  • McKenzie Family Healthcare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240710000404 MI Part A Provider - Rural Health Clinic 6406755289 Practice locations: Sandusky, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083472138. Details of each certification follow.

Rural health clinic certification: CCN 238776

Legal name
MCKENZIE MEMORIAL HOSPITAL
Doing business as
MCKENZIE FAMILY HEALTHCARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 27, 2024
Last certification
Nov 27, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
109 N Delaware St
Sandusky, MI 48471-1008
Related CCNs
231314

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1020435McKenzie Family Healthcare109 Delaware Street, Sandusky, MI 48471Certificate of waiverDec 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
McKenzie Memorial Hospital4 organizations share this tax ID, including this one
Part of
McKenzie Memorial Hospital

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

109 N Delaware St
Sandusky, MI 48471
Phone (810) 648-4219

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Larry Mitchell Individual Corporate DirectorBoard Member Apr 1, 2024
Michael Dreyer Individual Corporate DirectorBoard Member Apr 1, 2024
Billi Jo Hennika Individual Corporate OfficerCoo Apr 1, 2024
W-2 Managing Employee Apr 1, 2024
Tonya Kaufman Individual Corporate DirectorBoard Member Apr 1, 2024
Amy Ruedisueli Individual Corporate OfficerCfo Apr 1, 2024
W-2 Managing EmployeeCfo Apr 1, 2024
James L Sams Individual Corporate DirectorBoard Member Apr 1, 2024
McKenzie Memorial Hospital Organization, Sandusky, MI Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 2024 100%
Steve Barnett Individual Corporate OfficerCeo Apr 1, 2024
W-2 Managing EmployeeCeo Apr 1, 2024
Brandon Guibord Individual Corporate DirectorBoard Member Apr 1, 2024

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
McKenzie Health & WellnessSandusky, MI, CCN 238759 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2020
Peck Medical CenterPeck, MI, CCN 238777 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761004800000",
    "number": "1083472138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 N DELAWARE ST",
            "city": "SANDUSKY",
            "state": "MI",
            "postal_code": "484711009",
            "telephone_number": "810-648-6199",
            "fax_number": "810-648-3352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N DELAWARE ST",
            "city": "SANDUSKY",
            "state": "MI",
            "postal_code": "484711008",
            "telephone_number": "810-648-9677",
            "fax_number": "810-648-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKENZIE MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCKENZIE MEMORIAL HOSPITAL",
        "enumeration_date": "2024-03-12",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A",
        "authorized_official_last_name": "RUEDISUELI",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "810-648-6162"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McKenzie Family Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandusky, MI

Sources for this page

Verify at the official NPI Registry.