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Goodwill (Tables)
 12 Months Ended
Dec. 31, 2017
Goodwill [Abstract]  
Summary of Changes in Carrying Amount of Goodwill
The changes in the carrying amount of goodwill as of December 31, 2017 and 2016 consisted of the following (in thousands):
 
  
Year Ended
December 31, 2017
    
Year Ended
December 31, 2016
  
       
Beginning balance
 
$
226,806
  
$
195,373
 
Goodwill acquired during the year
  
44,292
   
31,419
 
Goodwill adjustments for purchase price allocation of businesses acquired in prior year
  
706
   
14
 
Goodwill written-off - closed clinic
  
(466
)
  
-
 
Ending balance
 
$
271,338
  
$
226,806