Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shane Thomas Kelly

Individual provider Certified Registered Nurse Anesthetist · NPI 1215629753

Shane Thomas Kelly is a Certified Registered Nurse Anesthetist (CRNA) in Royal Oak, Michigan. Qualified in 2023, 3 years ago. Practices with Spectrum Health Primary Care Partners, a 2,303-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
3
Licensed in
MI
In the registry since
2023
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Practice location Address checks out

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712
Phone: (248) 898-5000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 200 Jefferson Ave Se, Grand Rapids, MI 49503-4502 — (616) 685-5000
  • 100 Michigan St Ne, Grand Rapids, MI 49503 — (616) 364-4200
  • 3333 Evergreen Dr Ne, Grand Rapids, MI 49525 — (616) 364-4200

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 4704329144 (MI)

Record details

NPI number1215629753
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMay 23, 2023
Last updated in NPPESApril 23, 2026
Certification dateApril 23, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Spectrum Health Primary Care Partners — 2303 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Royal Oak