OrganizationActiveAccepts Medicare
Glen S Lovelace MD PA
NPI 1023053204 · Specialist · Boise, ID
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1023053204
- Entity type
- Organization
- Primary specialty
- SpecialistOther Service Providers
- Organization subpart
- No
- Authorized official
- Glen Lovelace, Owner(208) 345-3136
- License
- M6570 (ID)
Specialties & taxonomies
Other Service Providers
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
333 N 1st St Ste 260
Boise, ID 83702-6132
Phone: (208) 345-3136
Fax: (208) 345-0984
Street-level locationGet directions
Mailing address
333 N 1st St Ste 260
Boise, ID 83702-6132
Registry dates
- Enumerated
- 2006-06-19
- Last updated
- 2009-06-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.