McKenzie Ann Disrud, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RH1306 Issued in ND

Practice address

2100 S Columbia Rd Ste 114
Grand Forks, ND 58201-5895

Phone

(701) 516-4637

Fax

(877) 651-1381

NPI assigned

Jun 21, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• McKenzie Ann Brown Former name

Medicare fee-for-service enrollment

Enrolled in ND, MN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

University of North Dakota School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Legacy Medical LLCGroup PAC ID 0648698290, 18 clinicians

Legacy Primary Care PLLCGroup PAC ID 5799223491, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hia Hospice Hospice, Fargo, ND, CCN 351500
• Altru Hospital Hospital, Grand Forks, ND, CCN 350019

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JCIBCD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Medical LLC

  • Adult Medicine Physician
  • Bismarck, ND
  • NPI 1619594637

  MN, ND

  Medicare reassignment Care Compare group NPD
• Legacy Primary Care PLLC

  • Adult Medicine Physician
  • Grand Forks, ND
  • NPI 1265277115

  MN, ND

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Altru Health System

  • General Acute Care Hospital
  • Grand Forks, ND
  • NPI 1154346161

  Hospital

  Care Compare affiliation
• Hospice of the Red River Valley

  • Community Based Hospice Care Agency
  • Fargo, ND
  • NPI 1538253646

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1561075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1265093124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13238",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582083238",
            "telephone_number": "015-164-6377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 S COLUMBIA RD STE 114",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015895",
            "telephone_number": "701-516-4637",
            "fax_number": "877-651-1381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISRUD",
        "first_name": "MCKENZIE",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-21",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "F06191893",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "RH1306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MCKENZIE",
            "last_name": "BROWN",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elisa Laura Diederich
• Ann K Diepolder-Brown, MD
• Ronda Dietzler
• Jenna Difrischia, LAPC
• Sierra Rose Dirden, ATC
• Rhonda Waage Dockter, LICSW
• Doctors Hospital-Grand Forks, LLC
• Judith Ann Doeden, LSW
• Mariah Rose Dolan, PT
• Cheryl Rae Donarski

• All providers in Grand Forks, ND
• Family Nurse Practitioner in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.