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UNAUDITED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended 12 Months Ended
Sep. 30, 2023
Sep. 30, 2022
Sep. 30, 2023
Sep. 30, 2022
Dec. 31, 2022
OPERATING ACTIVITIES          
Net income including non-controlling interest $ 12,222 $ 12,821 $ 38,513 $ 40,059  
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities:          
Depreciation and amortization     11,582 10,950  
Provision for credit losses 1,525 1,336 4,600 4,192  
Equity-based awards compensation expense     5,451 5,462  
Change in deferred income taxes     5,393 6,077  
Change in revaluation of put-right liability 145 (785) 344 (771)  
Change in fair value of contingent earn-out consideration (187) (2,000) (197) (2,000)  
Equity in earnings of unconsolidated affiliate (206) (304) (806) (983)  
Gain on sale of clinics and fixed assets     (106) (643)  
Changes in operating assets and liabilities:          
Increase in patient accounts receivable     (5,415) (7,585)  
Increase in accounts receivable - other     (1,631) (4,551)  
Increase (decrease) in other current and long term assets     2,489 (4,273)  
Decrease in accounts payable and accrued expenses     (5,609) (4,568)  
Increase (decrease) in other long-term liabilities     535 (128)  
Net cash provided by operating activities     55,143 41,238  
INVESTING ACTIVITIES          
Purchase of fixed assets     (7,074) (7,290)  
Purchase of majority interest in businesses, net of cash acquired     (22,994) (18,573)  
Purchase of redeemable non-controlling interest, temporary equity     (7,804) (14,096)  
Purchase of non controlling interest-permanent equity     (262) (280)  
Proceeds on sale of partnership interest, clinics and fixed assets     7 740  
Proceeds on sale of non-controlling interest, permanent equity     30 0  
Proceeds on sale of partnership interest - redeemable non-controlling interest, temporary equity     815 401  
Distributions from unconsolidated affiliate     681 1,220  
Net cash used in investing activities     (36,601) (37,878)  
FINANCING ACTIVITIES          
Distributions to non-controlling interest, permanent and temporary equity     (11,777) (11,760)  
Cash dividends paid to shareholders     (17,683) (15,990)  
Proceeds from revolving facility     24,000 61,000  
Proceeds from term loan     0 150,000  
Proceeds from issuance of common stock pursuant to the secondary public offering, net of issuance costs     163,646 0  
Payments on revolving facility     (55,000) (175,000)  
Principal payments on notes payable     (2,874) (496)  
Payments on term loan     (2,813) (1,779)  
Other     50 12  
Net cash provided by financing activities     97,549 5,987  
Net decrease in cash and cash equivalents     116,091 9,347  
Cash and cash equivalents - beginning of period     31,594 28,567 $ 28,567
Cash and cash equivalents - end of period 147,685 37,914 147,685 37,914 $ 31,594
Cash paid during the period for:          
Income taxes     2,731 7,529  
Interest paid     6,992 2,159  
Non-cash investing and financing transactions during the period:          
Purchase of businesses - seller financing portion     1,860 824  
Notes payable related to purchase of redeemable non-controlling interest, temporary equity 1,017 1,074 1,017 1,074  
Notes receivable related to sale of redeemable non-controlling interest, temporary equity     3,064 1,580  
Notes payable related to the purchase of non-controlling interest, permanent equity $ 200 $ 576 200 576  
Notes receivable related to the sale of non-controlling interest, permanent equity     $ 397 $ 0