NPIMap

Organization Active NPI

The Commonwealth of Massachusetts

  • Clinical Medical Laboratory
  • Jamaica Plain, MA
National Provider Identifier
1093856965
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
THE COMMONWEALTH OF MASSACHUSETTS
Practice address
305 South St
Jamaica Plain, MA 02130-3515
Phone
(617) 983-6675
Fax
(857) 323-8352
NPI assigned
Feb 12, 2007
Organization subpart
Yes
Parent organization
THE COMMONWEALTH OF MASSACHUSETTSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Authorized official

Name
Matthew Courchene
Title
Chief Financial Officer
Phone
(617) 624-5309

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

305 South St
Jamaica Plain, MA 02130-3515

Mailing address

305 South St
Jamaica Plain, MA 02130-3515
Phone (617) 983-6201

Other names 1

  • Sexually Transmitted Infections (STI) Laboratory Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161107002470 MA Part B Supplier - Independent Clinical Laboratory 8820906860 Practice locations: Jamaica Plain, MA

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

National Provider Directory

National Provider Directory
Part of
C Stanley Raymond

Locations

529 Main St
Ste 320
Charlestown, MA 02129

305 South St
Fl 2
Jamaica Plain, MA 02130
Phone (617) 983-6739

Ownership & related parties

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tewksbury HospitalTewksbury, MA, CCN 222003 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Lemuel Shattuck HospitalJamaica Plain, MA, CCN 222006 Hospital Operational/Managerial Control (100%) Jul 1, 1966
Dr. John C Corrigan Mental Health CenterFall River, MA, CCN 224028 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 2, 1989
Solomon Carter Fuller Mental Health CenterBoston, MA, CCN 224040 Hospital Operational/Managerial Control (100%) Dec 26, 2008
Worcester Recovery Center and HospitalWorcester, MA, CCN 224032 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 17, 1992
Cape Cod and the Islands Mental Health CenterPocasset, MA, CCN 224031 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 2, 1989
Taunton State HospitalTaunton, MA, CCN 224001 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1986
Massachusetts Veterans' Home in ChelseaChelsea, MA, CCN 225110 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 1, 2023
Jul 1, 1966
Massachusetts Veterans' Home of HolyokeHolyoke, MA, CCN 225786 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 6, 2025
May 6, 2025

Owned or controlled facilities with NPI records 11

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779062400000",
    "number": "1093856965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 SOUTH ST",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021303515",
            "telephone_number": "617-983-6201",
            "fax_number": "857-323-8352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 SOUTH ST",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021303515",
            "telephone_number": "617-983-6675",
            "fax_number": "857-323-8352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE COMMONWEALTH OF MASSACHUSETTS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE COMMONWEALTH OF MASSACHUSETTS",
        "enumeration_date": "2007-02-12",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A",
        "authorized_official_last_name": "COURCHENE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "617-624-5309"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sexually Transmitted Infections (STI) Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jamaica Plain, MA

Sources for this page

Verify at the official NPI Registry.