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Goodwill (Tables)
12 Months Ended
Dec. 31, 2018
Goodwill [Abstract]  
Changes in Carrying Amount of Goodwill
The changes in the carrying amount of goodwill as of December 31, 2018 and 2017 consisted of the following (in thousands):

  
Year Ended
December 31, 2018
  
Year Ended
December 31, 2017
 
       
Beginning balance
 
$
271,338
  
$
226,806
 
Goodwill acquired during the year
  
19,778
   
44,292
 
Goodwill adjustments for purchase price allocation of businesses acquired in prior year
  
2,409
   
706
 
Goodwill written-off - closed clinic
  
-
   
(466
)
Ending balance
 
$
293,525
  
$
271,338