Individual provider Active NPI

Alec Hayes Fisher

  • Plastic and Reconstructive Surgery Physician
  • Bourbonnais, IL
National Provider Identifier
1386207702
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
036174352 Issued in IL
Practice address
300 Riverside Dr Ste 2700
Bourbonnais, IL 60914-5071
Phone
(779) 701-2762
Fax
(779) 701-2765
NPI assigned
Apr 22, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X 036174352 IL Primary

Addresses

Primary practice location

300 Riverside Dr Ste 2700
Bourbonnais, IL 60914-5071

Mailing address

300 Riverside Dr Ste 2700
Bourbonnais, IL 60914-5071
Phone (779) 701-2762

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250730000148 IL Practitioner - Plastic and Reconstructive Surgery 5193232544 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Geisel School of Medicine at Dartmouth, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverside Health SystemGroup PAC ID 3274434717, 202 clinicians

Practice addresses (Care Compare)

105 S 1St St
Willmington, IL 60481-8973
Phone (815) 476-5210

338 Larry Power Rd
Bourbonnais, IL 60914-4430
Phone (815) 935-2991

350 N Wall St 4TH Floor
Kankakee, IL 60901-2901
Phone 81593316714592

Hospital & facility affiliations

  • Riverside Medical Center Hospital, Kankakee, IL, CCN 140186

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036174352ILMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Health System Current Accepting new patients
Riverside Health System CurrentSince Jul 22, 2025 Accepting new patients

Locations

300 Riverside Dr
Ste 2100
Bourbonnais, IL 60914
Phone (815) 928-9666

300 Riverside Dr
Ste 2700
Bourbonnais, IL 60914
Phone (779) 701-2762

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1386207702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 RIVERSIDE DR STE 2700",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609145071",
            "telephone_number": "779-701-2762",
            "fax_number": "779-701-2765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 RIVERSIDE DR STE 2700",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609145071",
            "telephone_number": "779-701-2762",
            "fax_number": "779-701-2765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHER",
        "first_name": "ALEC",
        "middle_name": "HAYES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-22",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IL",
            "license": "036174352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bourbonnais, IL

Sources for this page

Verify at the official NPI Registry.