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GOODWILL AND OTHER INTANGIBLE ASSETS
 9 Months Ended
Sep. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill and Other Intangible Assets GOODWILL AND OTHER INTANGIBLE ASSETS
Changes in the carrying amount of goodwill consists of the following activity for the three and nine months ended September 30, 2020 (in thousands):
Balance at December 31, 2019$1,425,542 
Purchase accounting adjustments2,341 
Balance at March 31, 2020$1,427,883 
Purchase accounting adjustments727
Balance at June 30, 2020$1,428,610 
Changes—
Balance at September 30, 2020$1,428,610 
Changes in the carrying amount of goodwill consists of the following activity for the three and nine months ended September 30, 2019 (in thousands):
Balance at December 31, 2018$632,469 
Changes—
Balance at March 31, 2019$632,469 
Changes—
Balance at June 30, 2019$632,469 
Acquisitions786,904 
Balance at September 30, 2019$1,419,373 
The carrying amount and accumulated amortization of intangible assets consists of the following as of September 30, 2020 and December 31, 2019 (in thousands):
September 30, 2020December 31, 2019
Gross intangible assets:
Referral sources$438,121 $438,121 
Trademarks/names44,536 44,536 
Other amortizable intangible assets402 402 
Total gross intangible assets483,059 483,059 
Accumulated amortization:
Referral sources(103,947)(84,295)
Trademarks/names(19,046)(12,748)
Other amortizable intangible assets(300)(106)
Total accumulated amortization(123,293)(97,149)
Total intangible assets, net$359,766 $385,910 
Amortization expense for intangible assets was $8.8 million and $26.3 million for the three and nine months ended September 30, 2020, respectively. Amortization expense for intangible assets was $7.5 million and $17.3 million for the three and nine months ended September 30, 2019, respectively.