Alexis Marie Pothuraju, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-14773 Issued in NC

Practice address

3333 Brookview Hills Blvd Ste 204
Winston Salem, NC 27103-5661

Phone

(336) 774-3740

Fax

(336) 774-3780

NPI assigned

Sep 2, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Alexis Marie Van Ryswyk Former name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: avanryswyk1618584@direct.novanthealth.org

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.

• Forsyth Memorial Hospital, Inc.

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1104548874
  Medicare reassignment Care Compare group
• Forsyth Memorial Hospital, Inc.

  • Cardiovascular Disease Physician
  • Winston Salem, NC
  • NPI 1356101893
  NPD
• Forsyth Memorial Hospital, Inc.

  • Cardiovascular Disease Physician
  • Winston Salem, NC
  • NPI 1932935475
  NPD
• Forsyth Memorial Hospital, Inc

  • Family Medicine Physician
  • Mount Airy, NC
  • NPI 1295783108
  NPD (past)

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

• Forsyth Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1447200233
  Care Compare affiliation

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

{
    "created_epoch": "1725235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785715200000",
    "number": "1902630809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-774-3740",
            "fax_number": "336-774-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 BROOKVIEW HILLS BLVD STE 204",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035661",
            "telephone_number": "336-774-3740",
            "fax_number": "336-774-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTHURAJU",
        "first_name": "ALEXIS",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-02",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-14773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEXIS",
            "last_name": "VAN RYSWYK",
            "middle_name": "MARIE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hannah Elizabeth Porter, PA-C
• Royce Anthony Porter Jr., D.D.S.
• Yvette Marie Porter
• Martin A Portillo, MD
• Positive Innovated Beginnings, LLC
• Tejit Venkata Pothuraju
• Lawrence H. Potter Jr., MD
• Deepa Retnem Potti, M.D.
• Deborah Krist Potticary
• Melinda Sue Potts-Trippe, LMBT #101

• Physician Assistant in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.