NPIMap

Organization Active NPI

McKenzie Memorial Hospital

Doing business as McKenzie Professional Practice

  • Family Medicine Physician
  • Sandusky, MI
National Provider Identifier
1831443761
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MCKENZIE MEMORIAL HOSPITAL
Doing business as
McKenzie Professional Practice
Practice address
120 N Delaware St
Sandusky, MI 48471-1009
Phone
(810) 648-6162
Fax
(810) 648-5058
NPI assigned
Oct 30, 2012
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
V.P. of Finance
Phone
(810) 648-6162

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X
Orthopaedic Surgery Physician 207X00000X
Pediatrics Physician 208000000X

Addresses

Primary practice location

120 N Delaware St
Sandusky, MI 48471-1009

Mailing address

120 N Delaware St
Sandusky, MI 48471-1009
Phone (810) 648-6162

Other names 1

  • McKenzie Professional Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040310000552 MI Part B Supplier - Clinic/Group Practice 6406755289 Receives reassigned benefits from 54 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Port Sanilac, MI; Sandusky, MI; Croswell, MI
O20070815000307 MI Part A Provider - Critical Access Hospital 6406755289 Receives reassigned benefits from 29 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Croswell, MI; Peck, MI; Sandusky, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831443761. Details of each certification follow.

Hospital certification: CCN 231314

Legal name
MCKENZIE MEMORIAL HOSPITAL
Doing business as
MCKENZIE HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 1, 2002
Last certification
Dec 18, 2024
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
120 N Delaware St
Sandusky, MI 48471-1009
Other Hospital Practice Location

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
McKenzie Health SystemCCN 231314 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
McKenzie Memorial Hospital

Locations

8 N Howard Ave
Croswell, MI 48422
Phone (810) 679-0012

115 N Delaware St
Sandusky, MI 48471
Phone (810) 648-4544

120 N Delaware St
Sandusky, MI 48471
Phone (810) 648-3770

75 Dawson St
Sandusky, MI 48471
Phone (810) 648-2232

Interoperability endpoints

  • Direct secure messaging: ehr-direct@mckenziehealth.hin.us

Ownership & related parties

All disclosed owners & managing parties 8

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 Director Feb 1, 2009
Michael Dreyer Individual Corporate Director Aug 1, 2010
Billi Jo Hennika Individual W-2 Managing Employee May 1, 2013
Tonya Kaufman Individual Corporate Director Nov 28, 2023
Amy Ruedisueli Individual Corporate Officer Jul 9, 2011
W-2 Managing Employee Jul 9, 2011
James L Sams Individual Corporate Director Jan 1, 2017
Steve Barnett Individual W-2 Managing Employee May 12, 2008
Brandon Guibord Individual Corporate Director Jun 28, 2022

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

Affiliated clinicians 112

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 112

NPI Registry JSON

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761004800000",
    "number": "1831443761",
    "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": "810-648-6162",
            "fax_number": "810-648-5058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N DELAWARE ST",
            "city": "SANDUSKY",
            "state": "MI",
            "postal_code": "484711009",
            "telephone_number": "810-648-6162",
            "fax_number": "810-648-5058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKENZIE MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCKENZIE MEMORIAL HOSPITAL",
        "enumeration_date": "2012-10-30",
        "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": "V.P. OF FINANCE",
        "authorized_official_telephone_number": "810-648-6162"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McKenzie Professional Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "McKenzie Professional Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandusky, MI

Sources for this page

Verify at the official NPI Registry.