Shane Thomas Kelly

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4704329144 Issued in MI

Practice address

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

Phone

(248) 898-5000

NPI assigned

May 23, 2023

Last updated

Apr 23, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spectrum Health Primary Care PartnersGroup PAC ID 4587568647, 2,283 clinicians

Saint Mary's Health ServicesGroup PAC ID 4981500436, 175 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Health Saint Mary's Hospital, Grand Rapids, MI, CCN 230059
• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Saint Mary's Health Services

  • Anesthesiology Physician
  • Grand Rapids, MI
  • NPI 1124063078

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Spectrum Health Primary Care Partners

  dba Corewell Health Medical Group West

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1235188673
  Medicare reassignment Care Compare group NPD
• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Corewell Health Lakeland Hospitals

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Medicare reassignment NPD
• Northstar Anesthesia of Michigan III PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Irving, TX
  • NPI 1972126209

  MI, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Anesthesia Medical Consultants, PC

  • Anesthesiology Physician
  • Grand Rapids, MI
  • NPI 1063710689
  NPD
• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Corewell Health Lakeland Hospitals (MDPP)

  • Community Health Clinic/Center
  • Saint Joseph, MI
  • NPI 1184513731
  NPD
• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Spectrum Health Lakeland Anesthesia

  • Anesthesiology Physician
  • Saint Joseph, MI
  • NPI 1598305641

  Nurse Anesthetist, Certified Registered

  NPD
• Saint Mary's Health Services

  dba Mercy Health Saint Mary's

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1639111057
  NPD
• Spectrum Health Primary Care Partners

  dba Corewell Health Medical Group West

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1689499667
  NPD
• West Michigan Anesthesia, PC

  • Anesthesiology Physician
  • Grand Rapids, MI
  • NPI 1225016926
  NPD

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

• Pennock Hospital

  dba Corewell Health Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Saint Mary's Health Services

  dba Mercy Health Saint Mary's

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1639111057
  Care Compare affiliation
• Spectrum Health Hospitals

  dba Corewell Health Grand Rapids Hospital

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

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

{
    "created_epoch": "1684800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776902400000",
    "number": "1215629753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259493",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "248-898-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3333 Evergreen Dr NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "49525",
            "country_code": "US",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Michigan St NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "49503",
            "country_code": "US",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Jefferson Ave SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495034502",
            "country_code": "US",
            "telephone_number": "616-685-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHANE",
        "middle_name": "THOMAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-23",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704329144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Usha Kellampalli, MBBS
• Samuel Wheeler Kelland, PT, DPT
• Paul S Kellerman, MD
• Angela Kello, FNP-BC
• Hannah Kelly-McFarland
• Stephanie Josephine Kelly, D.C.
• Ryan Kelsch, DO
• Jessica Kenaya, MSN, RN, CPNP-PC
• Ada L Kendall, MD
• Aidan Kennedy, MD

• Certified Registered Nurse Anesthetist in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Certified Registered Nurse Anesthetist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.