MRS. MCKENZIE ANN DISRUD FNP
NPI 1265093124
Nurse Practitioner - Family in Grand Forks, ND

Q: What is Mckenzie Disrud's NPI number?

The NPI number for Mckenzie Disrud is 1265093124. It was assigned to this individual provider in the NPPES registry on June 21, 2019. The provider is also known as Mckenzie Ann Brown.

Q: What is Mckenzie Disrud's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Mckenzie Disrud was last updated on January 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months 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.

Active since June 21, 2019PECOS EnrolledAccepts Medicare Assignment

2100 S COLUMBIA RD STE 114, GRAND FORKS, ND 58201(701) 516-4637(877) 651-1381 Get Directions Write a Review

NPPES record last updated: January 30, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 15, 2021, Feb 12, 2020, Jun 21, 2019 (3 updates tracked since 2019).

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About Mrs. Mckenzie Ann Disrud Fnp NPPES

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

MRS. MCKENZIE ANN DISRUD FNP (NPI 1265093124) is an individual family provider in Grand Forks, North Dakota, licensed in North Dakota (RH1306) and active in the NPI registry since June 2019. She is enrolled in Medicare PECOS, is affiliated with Altru Hospital, and is a graduate of University Of North Dakota School Of Medicine (2019).

NPPES Registry Identity

NPI1265093124

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameMRS. MCKENZIE ANN DISRUDCredential: FNP

Location Address2100 S COLUMBIA RD STE 114Grand Forks, ND 58201-5895

Mailing AddressPo Box 13238Grand Forks, ND 58208-3238 · (015) 164-6377

Phone(701) 516-4637

Fax(877) 651-1381

Sole ProprietorNo

Medical School CMSUniversity Of North Dakota School Of MedicineGraduated 2019

Enumeration DateJune 21, 2019

Last NPPES UpdateJanuary 30, 20253 updates tracked since enumeration

NPPES CertifiedJanuary 30, 2025

✔ NPI 1265093124 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

Licenses✔ Licensed in ND · RH1306✔ Licensed in ND · F06191893

Also ListedPhysician Assistant · SurgicalTaxonomy 363AS0400X

2100 S COLUMBIA RD STE 114, Grand Forks, ND 58201

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Other Names 1

Former Name (1)Mckenzie Ann Brown

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of North Dakota, Sanford Health Plan, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Mckenzie Ann Disrud Fnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4385972678

PECOS Enrollment IDI20190823003008, I20250217002071

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

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

Legacy Primary Care PLLC

Same address

Adult Medicine

2100 S COLUMBIA RD STE 114
Grand Forks, ND 58201

Reassigned Medicare billing, Minnesota and North Dakota enrollments
5 clinicians in this Medicare group

NPI 1265277115 (701) 516-4637

Legacy Medical LLC

191 mi

Adult Medicine

600 S 2ND ST STE 200
Bismarck, ND 58504

Reassigned Medicare billing, Minnesota and North Dakota enrollments
5 clinicians in this Medicare group

NPI 1619594637 (701) 516-4637

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

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Altru Hospital

Acute Care Hospitals · Grand Forks, ND

3/5 CMS rating

OwnershipGovernment - Local

CMS Certification Number350019

Location1200 S Columbia RdGrand Forks, ND 58201 · Grand Forks County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 58201 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

$85.71 typical visit price

range $55.75 – $168.12

Typical copayment $21.42 (range $13.93 – $42.03)

Most-billed visit code 99203

Established Patient

$98.29 typical visit price

range $18.11 – $137.65

Typical copayment $24.57 (range $4.52 – $34.41)

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 8

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

TRACI SPECHT

Nurse Practitioner (Family)