County of Fulton

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

0014290 Issued in IL

Legal business name

COUNTY OF FULTON

Doing business as

The Clayberg Fulton County Nursing Center

Practice address

625 East Monroe Street
Cuba, IL 61427-0200

Phone

(309) 785-5012

Fax

(309) 785-5376

NPI assigned

Mar 14, 2007

Last updated

Nov 2, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Martha J Danielson, LNHA

Title

Administrator

Phone

(309) 785-5012

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• The Clayberg Fulton County Nursing Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497889554. Details of each certification follow.

• CCN 146151 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 146151

Legal name

COUNTY OF FULTON

Doing business as

CLAYBERG, THE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jul 7, 2011

Last certification

Apr 4, 2025

Beds

49

Ownership / control type

County

Organization structure

OtherNon-profit

Incorporated

Jul 6, 1969 in IL

Enrollment address

625 E Monroe St
Cuba, IL 61427-5109

Nursing home name

CLAYBERG, THE

Listed as

Clayberg, theCCN 146151 · All quality measures

Overall star rating

5 of 5

Health inspections

5 of 5

Staffing

4 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

Government - County

Certified

Jul 7, 2011

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4942.6 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Tax ID family

County of Fulton2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• County of Fulton

  • Public Health or Welfare Agency
  • Lewistown, IL
  • NPI 1528379906
  NPD tax ID

Locations

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 2

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.

• Theresa Bankert, APN

  • Women's Health Nurse Practitioner
  • Canton, IL
  • NPI 1275662157
  NPD (past)
• Graciela Grammer, DDS

  • Dentist
  • Canton, IL
  • NPI 1982829420
  NPD (past)

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• William Bailey, M.D.

  • Family Medicine Physician
  • Canton, IL
  • NPI 1598020836

  Nursing home

  Care Compare affiliation
• Joshua Bowers, M.D.

  • Family Medicine Physician
  • Canton, IL
  • NPI 1194947002

  Nursing home

  Care Compare affiliation
• Kenneth R. Krock, MD

  • Internal Medicine Physician
  • Canton, IL
  • NPI 1699883868

  Nursing home

  Care Compare affiliation
• Benjamin William Phillips, MD

  • Internal Medicine Physician
  • Canton, IL
  • NPI 1275678021

  Nursing home

  Care Compare affiliation
• Patrick Barry Renick, MD

  • Family Medicine Physician
  • Canton, IL
  • NPI 1760604193

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351814400000",
    "number": "1497889554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 200",
            "address_2": "625 EAST MONROE STREET",
            "city": "CUBA",
            "state": "IL",
            "postal_code": "614270200",
            "telephone_number": "309-785-5012",
            "fax_number": "309-785-5376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 EAST MONROE STREET",
            "city": "CUBA",
            "state": "IL",
            "postal_code": "614270200",
            "telephone_number": "309-785-5012",
            "fax_number": "309-785-5376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF FULTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2012-11-02",
        "status": "A",
        "authorized_official_last_name": "DANIELSON",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "309-785-5012",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IL",
            "license": "0014290",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0014290",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370914241001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Clayberg Fulton County Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly Dawn Bordner, MA, LCPC
• Sydney K Collins
• Terrah L Cornell, FNP
• Bridgette Dennis, MS CCC-SLP
• Fulton County Comm Dist 3
• Graham Hospital Association (Graham Medical Group)
• Marcia Anne Heitz, LCSW
• Megan Kathleen Holliger, PTA

• Nursing Facility/Intermediate Care Facility in Cuba, IL
• Providers in Cuba, IL by specialty
• Nursing Facility/Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.