EXTENDED FAMILY MEDICAL CLINIC
NPI 1720121395
Family Medicine in Mobile, AL

NPI Status: Active since February 14, 2007

Contact Information

108 N CATHERINE ST
SUITE A
MOBILE, AL
ZIP 36604
Phone: (251) 438-7170
Fax: (251) 438-7173

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  • Organization
  • Family Medicine
  • CLIA Number: 01D1058526
  • CLIA Cert. Type: Practitioner Other
  • CLIA Exp. Date: 09-06-2026

About EXTENDED FAMILY MEDICAL CLINIC

This page provides the complete NPI Profile along with additional information for Extended Family Medical Clinic, a primary care provider established in Mobile, Alabama operating as a Family Medicine. The healthcare provider is registered in the NPI registry with number 1720121395 assigned on February 2007. The practitioner's primary taxonomy code is 207Q00000X. The provider is registered as an organization and their NPI record was last updated one year ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Angelia Deniese Blackmon Crnp (Medical Director)

NPI
1720121395
Provider Name
EXTENDED FAMILY MEDICAL CLINIC
Entity Type
Organization
Location Address
108 N CATHERINE ST SUITE A MOBILE, AL 36604
Location Phone
(251) 438-7170
Location Fax
(251) 438-7173
Mailing Address
108 N CATHERINE ST SUITE A MOBILE, AL 36604
Mailing Phone
(251) 438-7170
Mailing Fax
(251) 438-7173
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
02-14-2007
Last Update Date
03-19-2025
Code Navigator

A primary care provider (PCP) like Extended Family Medical Clinic sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Family Medicine

Taxonomy Code
207Q00000X
Type
Allopathic & Osteopathic Physicians
Taxonomy Description
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1261Q00000XAmbulatory Health Care Facilities

Clinic/Center

1-073404 (AL)

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

ANGELIA DENIESE BLACKMON CRNP

Authorized Official Title
MEDICAL DIRECTOR
Authorized Official Phone
(251) 438-7170

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
01D1058526
Facility Type
Practitioner Other
Certificate Effective Date
September 07, 2024
Certificate Expiration Date
September 06, 2026
Laboratory Director
ANGELIA D. BLACKMON
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Extended Family Medical Clinic to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1720121395, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 55. The final step is to find the difference between that total and the next multiple of ten (60 - 55 = 5).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
7
Unchanged
Pos 3
2
Doubled → 4
Pos 4
0
Unchanged
Pos 5
1
Doubled → 2
Pos 6
2
Unchanged
Pos 7
1
Doubled → 2
Pos 8
3
Unchanged
Pos 9
9
Doubled → 18 → 1 + 8
Check
5
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 2 → 4 1 → 2 1 → 2 9 → 18 → 9

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 7 + 4 + 0 + 2 + 2 + 2 + 3 + 1 + 8 + 24 = 55

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 55 is 60. The difference is the calculated check digit.

60 - 55 = 5
This NPI is valid
The calculated check digit is 5, which matches the last digit of 1720121395.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1720121395, enumerated as an "organization" on February 14, 2007.

The provider is located at 108 N CATHERINE ST SUITE A MOBILE, AL 36604 and the phone number is (251) 438-7170.

Family Medicine with taxonomy code 207Q00000X.