Shane Thomas Kelly, in Royal Oak, MI - Medicare Nurse Anesthetist, Certified Registered

Shane Thomas Kelly, is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Royal Oak, Michigan. His current practice location is 3601 W 13 Mile Rd, Royal Oak, Michigan. You can reach out to his office (for appointments etc.) via phone at (248) 898-5000.

Shane Thomas Kelly is licensed to practice in Michigan (license number 4704329144) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1215629753.

Contact Information

	Shane Thomas Kelly,
	3601 W 13 Mile Rd, Royal Oak, MI 48073-6712
	(248) 898-5000
	Not Available

Map and Direction

Provider's Profile

Full Name	Shane Thomas Kelly
Gender	Male
Speciality	Nurse Anesthetist, Certified Registered
Location	3601 W 13 Mile Rd, Royal Oak, Michigan
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1215629753
Provider Enumeration Date: 05/23/2023
Last Update Date: 10/20/2024

Medicare PECOS Information:

PECOS PAC ID: 7719340116
Enrollment ID: I20230901001499

Medical Identifiers

Medical identifiers for Shane Thomas Kelly such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1215629753	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
163W00000X	Registered Nurse	4704329144 (Michigan)	Secondary
367500000X	Nurse Anesthetist, Certified Registered	4704329144 (Michigan)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Shane Thomas Kelly allows following entities to bill medicare on his behalf.

Entity Name	Northstar Anesthesia Of Michigan Iii Pllc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1972126209 PECOS PAC ID: 7911325469 Enrollment ID: O20200915001990

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shane Thomas Kelly is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Shane Thomas Kelly, 3333 Evergreen Dr Ne, Grand Rapids, MI 49525-9493 Ph: (616) 364-4200	Shane Thomas Kelly, 3601 W 13 Mile Rd, Royal Oak, MI 48073-6712 Ph: (248) 898-5000

Reviews and Comments

Nurse Anesthetist, Certified Registered Nurses in Royal Oak, MI

Ban Batu, CRNA Nurse Anesthetist - CR Medicare: May Accept Medicare Assignments Practice Location: 3601 W 13 Mile Rd, Royal Oak, MI 48073 Phone: 248-423-3144
Amie Hamper, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 3601 W 13 Mile Rd, Royal Oak, MI 48073 Phone: 248-898-7784 Fax: 248-898-8181
Michelle Glaeser, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 3601 W 13 Mile Rd, 400 Fsc - Pcs, Royal Oak, MI 48073 Phone: 248-423-3144
Thomas Lundblad, CRNA Nurse Anesthetist - CR Medicare: May Accept Medicare Assignments Practice Location: 3601 W 13 Mile Rd, 400 Fsc - Pcs, Royal Oak, MI 48073 Phone: 248-423-3144
Patricia Ljubic, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 3601 W 13 Mile Rd, 400 Fsc - Pcs, Royal Oak, MI 48073 Phone: 248-423-3144
Catherine Wolfson, CRNA Nurse Anesthetist - CR Medicare: May Accept Medicare Assignments Practice Location: 3601 W. 13 Mile Rd, 400 Fsc-pcs, Royal Oak, MI 48073 Phone: 248-423-2481
Nancy Berner, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 3601 W 13 Mile Rd, Beaumont Hospital - Royal Oak, Royal Oak, MI 48073 Phone: 248-898-7784 Fax: 248-898-8181

Shane Thomas Kelly, - Medicare Nurse Anesthetist, Certified Registered in Royal Oak, MI