Organization Active NPI

Bespoke Primary Care, PLLC

  • Family Medicine Physician
  • Wellesley, MA
National Provider Identifier
1396617114
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BESPOKE PRIMARY CARE, PLLC
Practice address
60 Walnut St BSMT
Wellesley, MA 02481-2151
Phone
(617) 531-9503
NPI assigned
Sep 22, 2025
Last updated
Sep 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Authorized official

Name
Dr. Michael Richardson, MDNPI 1124430160
Title
Medical Director
Phone
(617) 531-9503

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

60 Walnut St BSMT
Wellesley, MA 02481-2151

Mailing address

60 Walnut St BSMT
Wellesley, MA 02481-2151
Phone (617) 531-9503

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260225000150 MA Part B Supplier - Clinic/Group Practice 6608357959 Receives reassigned benefits from 1 practitioner
Practice locations: Wellesley, MA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D2331608Bespoke Primary Care, LLC60 Walnut Street, Wellesley, MA 02481Certificate of waiverOct 5, 2027

National Provider Directory

National Provider Directory

Locations

60 Walnut St
Bsmt
Wellesley, MA 02481
Phone (617) 531-9503

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1758499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758499200000",
    "number": "1396617114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 WALNUT ST BSMT",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024812151",
            "telephone_number": "617-531-9503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 WALNUT ST BSMT",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024812151",
            "telephone_number": "617-531-9503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BESPOKE PRIMARY CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-22",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "617-531-9503",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellesley, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; 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.