SHANE THOMAS KELLY
NPI 1215629753
Nurse Anesthetist, Certified Registered in Royal Oak, MI

Q: What is Shane Kelly's NPI number?

The NPI number for Shane Kelly is 1215629753. It was assigned to this individual provider in the NPPES registry on May 23, 2023.

Q: What is Shane Kelly's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Q: When was this NPI record last updated?

The NPPES record for Shane Kelly was last updated on April 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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 May 23, 2023Accepts Medicare Assignment

3601 W 13 MILE RD, ROYAL OAK, MI 48073(248) 898-5000 Get Directions Write a Review

NPPES record last updated: April 23, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 23, 2026, May 9, 2024, May 23, 2023 (3 updates tracked since 2023).

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About Shane Thomas Kelly NPPES

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

SHANE THOMAS KELLY (NPI 1215629753) is an individual nurse anesthetist, certified registered in Royal Oak, Michigan, licensed in Michigan (4704329144) and active in the NPI registry since May 2023. He is affiliated with Spectrum Health, maintains 3 additional practice locations, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1215629753

Entity TypeIndividualMale

Primary Taxonomy367500000X

Provider Legal NameSHANE THOMAS KELLY

Location Address3601 W 13 MILE RDRoyal Oak, MI 48073-6712

Mailing Address3333 Evergreen Dr NeGrand Rapids, MI 49525-9493 · (616) 364-4200 · Fax (616) 364-7347

Phone(248) 898-5000

Sole ProprietorYes

Medical School CMSOtherGraduated 2023

Enumeration DateMay 23, 2023

Last NPPES UpdateApril 23, 20263 updates tracked since enumeration

NPPES CertifiedApril 23, 2026

✔ NPI 1215629753 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code367500000X

License✔ Licensed in MI · 4704329144

Definition

(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.

3601 W 13 MILE RD, Royal Oak, MI 48073

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Secondary Practice Locations 3

Location 13333 Evergreen Dr NEGrand Rapids, MI 49525 · Phone (616) 364-4200 · Fax (616) 364-7347

Location 2200 Jefferson Ave SEGrand Rapids, MI 49503-4502 · Phone (616) 685-5000

Location 3100 Michigan St NEGrand Rapids, MI 49503 · Phone (616) 364-4200 · Fax (616) 364-7347

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Shane Thomas Kelly 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 ID7719340116

PECOS Enrollment IDI20230901001499

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Anesthesia for other procedure on esophagus, stomach, or upper small bowel using an endoscope 00731

This procedure involves the use of an endoscope, a flexible tube with a light and camera, to examine your esophagus, stomach, or upper small bowel. Anesthesia ensures you are comfortable and pain-free during the procedure.

13 services13 patients

Hospital Affiliations CMS Care Compare 2

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

Spectrum Health

Acute Care Hospitals · Grand Rapids, MI

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number230038

Location100 Michigan St NEGrand Rapids, MI 49503 · Kent County

Emergency services Birthing friendly

Mercy Health Saint Mary's

Acute Care Hospitals · Grand Rapids, MI

4/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number230059

Location200 Jefferson Avenue SEGrand Rapids, MI 49503 · Kent County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48073 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

$134.28 typical visit price

range $58.04 – $177.36

Typical copayment $33.57 (range $14.51 – $44.34)

Most-billed visit code 99204

Established Patient

$72.38 typical visit price

range $18.32 – $143.49

Typical copayment $18.09 (range $4.58 – $35.87)

Most-billed visit code 99213

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 20

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

AMIT BAHL MD, MPH

Emergency Medicine

3601 W 13 MILE RD, WILLIAM BEAUMONT HOSPITAL
ROYAL OAK, MI 48073

Oakland County (248) 898-0575

CATHERINE LEE PA

Physician Assistant